Low manipulation prevalence following fast-track total knee arthroplasty: A multicenter cohort study involving 3,145 consecutive unselected patients

TY - JOUR

T1 - Low manipulation prevalence following fast-track total knee arthroplasty

T2 - A multicenter cohort study involving 3,145 consecutive unselected patients

AU - Husted, Henrik

AU - Jørgensen, Christoffer C

AU - Gromov, Kirill

AU - Troelsen, Anders

AU - Collaborative Group of the Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement

PY - 2015/2

Y1 - 2015/2

N2 - BACKGROUND AND PURPOSE: Postoperative joint stiffness following total knee arthroplasty (TKA) may compromise the outcome and necessitate manipulation. Previous studies have not been in a fast-track setting with optimized pain treatment, early mobilization, and short length of stay (LOS), which may have influenced the prevalence of joint stiffness and subsequent manipulation. We investigated the prevalence of manipulation following fast-track TKA and identified patients at risk of needing manipulation.PATIENTS AND METHODS: 3,145 consecutive unselected elective primary unilateral TKA patients operated in 6 departments with well-defined fast-track settings were included in the study. Demographic data, prevalence, type and timing of manipulation, and preoperative and postoperative ROM were recorded prospectively, ensuring complete 1-year follow-up.RESULTS: 70 manipulations were performed within 1 year (2.2%) at a mean of 4 months after index surgery. Younger age and not using walking aids preoperatively were associated with a higher risk of manipulation. LOS ≤ 4 days (as opposed to a longer LOS) was not associated with an increased risk of manipulation.INTERPRETATION: The prevalence of manipulation was lower or comparable to that in most published studies following more conventional pathways. Inherent patient demographics were identified as risk factors for manipulation whereas LOS ≤ 4 days was not. Thus, fast-track TKA does not result in increased risk of manipulation-despite a shorter LOS. Optimized pain treatment and early mobilization may contribute to these favorable results that support the use of fast-track.

AB - BACKGROUND AND PURPOSE: Postoperative joint stiffness following total knee arthroplasty (TKA) may compromise the outcome and necessitate manipulation. Previous studies have not been in a fast-track setting with optimized pain treatment, early mobilization, and short length of stay (LOS), which may have influenced the prevalence of joint stiffness and subsequent manipulation. We investigated the prevalence of manipulation following fast-track TKA and identified patients at risk of needing manipulation.PATIENTS AND METHODS: 3,145 consecutive unselected elective primary unilateral TKA patients operated in 6 departments with well-defined fast-track settings were included in the study. Demographic data, prevalence, type and timing of manipulation, and preoperative and postoperative ROM were recorded prospectively, ensuring complete 1-year follow-up.RESULTS: 70 manipulations were performed within 1 year (2.2%) at a mean of 4 months after index surgery. Younger age and not using walking aids preoperatively were associated with a higher risk of manipulation. LOS ≤ 4 days (as opposed to a longer LOS) was not associated with an increased risk of manipulation.INTERPRETATION: The prevalence of manipulation was lower or comparable to that in most published studies following more conventional pathways. Inherent patient demographics were identified as risk factors for manipulation whereas LOS ≤ 4 days was not. Thus, fast-track TKA does not result in increased risk of manipulation-despite a shorter LOS. Optimized pain treatment and early mobilization may contribute to these favorable results that support the use of fast-track.

KW - Adult

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Arthroplasty, Replacement, Knee

KW - Clinical Protocols

KW - Dependent Ambulation

KW - Early Ambulation

KW - Female

KW - Humans

KW - Male

KW - Manipulation, Orthopedic

KW - Middle Aged

KW - Pain Management

KW - Perioperative Care

KW - Range of Motion, Articular

KW - Young Adult

U2 - 10.3109/17453674.2014.964615

DO - 10.3109/17453674.2014.964615

M3 - Journal article

C2 - 25267501

SN - 1745-3674

VL - 86

SP - 86

EP - 91

JO - Acta Orthopaedica

JF - Acta Orthopaedica

IS - 1

ER -