gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie
74. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie
96. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie
51. Tagung des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie

26. - 29.10.2010, Berlin

A multimodal regime allowing early mobilisation and discharge following total knee arthroplasty

Meeting Abstract

  • A. Siegmeth - Golden Jubilee National Hospital, Department of Orthopaedics, Glasgow, United Kingdom
  • A. Kinninmonth - Golden Jubilee National Hospital, Department of Orthopaedics, Glasgow, United Kingdom
  • D. Mcdonald - Golden Jubilee National Hospital, Physipotherapy, Glasgow, United Kingdom
  • R. Siegmeth - Golden Jubilee National Hospital, Department of Anaesthesia, Glasgow, United Kingdom
  • A. Deakin - Golden Jubilee National Hospital, Department of Orthopaedics, Glasgow, United Kingdom
  • N. Scott - Golden Jubilee National Hospital, Department of Anaesthesia, Glasgow, United Kingdom

Deutscher Kongress für Orthopädie und Unfallchirurgie. 74. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 96. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 51. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 26.-29.10.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocIN24-231

DOI: 10.3205/10dkou154, URN: urn:nbn:de:0183-10dkou1543

Veröffentlicht: 21. Oktober 2010

© 2010 Siegmeth et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Patients undergoing total knee arthroplasty (TKA) experience significant post-operative pain. Traditional intra-and postoperative pain management modalities focus on epidural analgesia and peripheral nerve blocks. Both provide excellent pain relief but do not facilitate early mobilisation on the day of surgery.

We report the results of a new comprehensive patient care plan to manage peri-operative pain, enable early mobilisation and reduce length of hospital stay in TKA.

Methods: A prospective single centre study of 1081 patients undergoing primary TKA during 2008 and 2009 was completed. All patients followed a planned programme including pre-operative patient education, pre-emptive analgesia, spinal anaesthesia with propofol sedation, intra-articular soft tissue wound infiltration, post-operative high volume intermittent ropivacaine boluses with an intra-articular catheter and early mobilisation. The primary outcome measure was the day of discharge from hospital. Secondary outcomes were verbal rating pain scores on movement, time to first mobilisation, nausea and vomiting scores, urinary catheterisation for retention, need for rescue analgesia, maximum flexion at discharge and six weeks post-operatively, and Oxford score improvement

Results and conclusions: The median day of discharge to home was post-operative day four. Median pain score on mobilisation was three for first post-operative night, day one and two. 35% of patients ambulated on the day of surgery and 95% of patients within 24 hours. 79% patients experienced no nausea or vomiting. Catheterisation rate was 6.9%. Rescue analgesia was required in 5% of cases. Median maximum flexion was 85° on discharge and 93° at six weeks post-operatively. Only 6.6% of patients had a reduction in maximum flexion (loss of more than 5°) at six weeks. Median Oxford score had improved from 42 pre-operatively to 27 at six weeks post-operatively. The infection rate was 0.7% and the DVT and PE rates were 0.6% and 0.5% respectively.

This multidisciplinary approach provides satisfactory post-operative analgesia allowing early safe ambulation and discharge from hospital. Anticipated problems did not arise, with early discharge not being detrimental to flexion achieved at six weeks and infection rates not increasing with the use of intra-articular catheters.