Excellent PROM results after fast-track hip and knee arthroplasty with no postoperative restrictions: a cohort study validation of fast-track surgery without postoperative restrictions

Aksel Paulsen; Ane Djuv; Jarle Ludvigsen; Ingvild Dalen

doi:10.1186/s12891-022-05276-y

Excellent PROM results after fast-track hip and knee arthroplasty with no postoperative restrictions: a cohort study validation of fast-track surgery without postoperative restrictions

BMC Musculoskelet Disord. 2022 Apr 5;23(1):324. doi: 10.1186/s12891-022-05276-y.

Authors

Aksel Paulsen^{1

2}, Ane Djuv^{3

4}, Jarle Ludvigsen³, Ingvild Dalen⁴

Affiliations

¹ Department of Orthopaedic Surgery, Stavanger University Hospital, Stavanger, Norway. aksel.paulsen@sus.no.
² Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway. aksel.paulsen@sus.no.
³ Department of Orthopaedic Surgery, Stavanger University Hospital, Stavanger, Norway.
⁴ Department of Research, Stavanger University Hospital, Stavanger, Norway.

Abstract

Background: Fast-track hip and knee arthroplasty (HA and KA) has been increasingly common over the last decade. In the same time period, there was a strong trend toward less restrictive mobilization. However, few reports have been published on combining these novel programs while measuring the postoperative results by patient-reported outcome measures (PROMs). Descriptions of fast-track surgery programs and their results are warranted.

Methods: The aim of this retrospective cohort study was to examine if it is possible to achieve excellent PROM results for hip and knee arthroplasty patients in a fast-track pathway without postoperative restrictions. During 2014-2017, the stepwise introduction of a PROM program was implemented at Stavanger University Hospital for all scheduled HA and KA patients, with preoperative assessments and postoperative follow-ups at the outpatient clinic. Standardized information with a focus on early mobilization and no postoperative restrictions was also initiated for the same patients. The generic EuroQol questionnaire (EQ-5D) and either the Hip or Knee disability/injury and Osteoarthritis Outcome Score (HOOS or KOOS) were used.

Results: PROM response rates varied from 80 to 99%. The median (interquartile range) change from preoperative to one-year postoperative results were as follows for HA and KA patients, respectively: pain, 55 (43-68) and 47 (31-61); other symptoms, 50 (40-65) and 36 (19-50); function in daily living, 54 (41-65) and 44 (31-55); function in sports and recreation, 56 (38-75) and 40 (15-64); joint-related quality of life, 69 (50-81) and 56 (38-75). The length of stay (LOS) was reduced by 1.9 days (mean), corresponding to a 40% reduction for HA patients and a 37% reduction for KA patients.

Conclusions: We found excellent PROM results after fast-track HA and KA with no postoperative restrictions. We believe that a fast-track program focusing on mobilization without any postoperative restrictions is superior for most patients, but further comparative studies are warranted.

Keywords: Arthroplasty; Fast-track; Hip; Knee; No postoperative restrictions; Patient reported outcome measures.

MeSH terms

Arthroplasty, Replacement, Hip* / adverse effects
Arthroplasty, Replacement, Hip* / methods
Arthroplasty, Replacement, Knee* / adverse effects
Arthroplasty, Replacement, Knee* / methods
Cohort Studies
Humans
Patient Reported Outcome Measures
Quality of Life
Retrospective Studies