Safety of Total Knee Replacement Surgery Before and After the Implementation of Enhanced Recovery Program

Completed

Brief Summary: The objectives are to describe the transition from traditional care to an enhanced recovery program for the management of total knee arthroplasty, and to evaluate the effect on patient outcomes.

Detailed Description: Enhanced recovery programs are an organizational evolution in surgical patient management, in which the patient becomes an actor of his or her own recovery. This multimodal approach aims at optimizing patient physiological and psychological states across preoperative, intraoperative and postoperative domains of care.

At la Rochelle hospital, the decision to take the step happened at the end of 2016. It was proposed by a young surgeon that have been trained on this new approach during his studies and who convinced the head of the surgery department of the benefits for the patients, the healthcare workers, and the institution. The transition took place in two stages, first operative and postoperative techniques were modified, and then preoperative education and counselling were added.

Recruitment & Eligibility

Inclusion Criteria

Patients operated on for posterior-stabilized total knee arthroplasty between January 2015 and December 2018
unilateral arthroplasty
a known address for mailing the study information letter

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Full enhanced recovery program	Enhanced recovery program	Patients were managed in an enhanced recovery program (elements of the previous fast-track program were modified and preoperative education was added)
Some elements of a fast-track program	Enhanced recovery program	operative and postoperative techniques were modified according to a fast-track program

Primary Outcome Measures

Name	Time	Method
Number of Patients With Early Complication	3 months after surgery	Recorded complications were Bleeding, Deep periprosthetic joint infection, Implant fracture, Instability, Patellofemoral dislocation, Readmission, Reoperation, Revision, Stiffness, Thromboembolic disease, Tibiofemoral dislocation, Vascular injury, Wound complication.

Secondary Outcome Measures

Name	Time	Method
Number of Patients With Late Complication	up to 28 months after surgery	Recorded complications were Bleeding, Deep periprosthetic joint infection, Implant fracture, Instability, Patellofemoral dislocation, Readmission, Reoperation, Revision, Stiffness, Thromboembolic disease, Tibiofemoral dislocation, Vascular injury, Wound complication.
Length of Hospital Stay	up to 1 month after surgery	the time between admission for an operation and discharge from the hospital
Preoperative Knee Extension	up to 1 month before surgery	Measure in degree of how much the knee straightens during consultation with surgeon
Postoperative Knee Extension	At 3 months after surgery	Measure in degree of how much the knee straightens during consultation with surgeon
Preoperative Knee Flexion	up to 1 month before surgery	Measure in degree of how much the knee bends during consultation with surgeon
Postoperative Knee Flexion	At 3 months after surgery	Measure in degree of how much the knee bends during consultation with surgeon