Feasibility of Outpatient Total Knee Arthroplasty
Condition: Osteoarthritis Of Knee
MeSH terms: Osteoarthritis, Knee
Study type: Observational

Summary: 
      This proposal outlines the investigators plan to develop, evaluate and implement an
      accelerated in hospital and community rehabilitation following total knee arthroplasty (TKA)
      leading to outpatient TKA. The benefits of applying current concepts of improved
      postoperative analgesia and less invasive surgical technique are expected to improve
      objective parameters of knee function, increase patients satisfaction, while reducing health
      care resources requirements as compared with standard rehabilitation. The innovation of
      combining best practices from orthopaedic sports medicine, Anesthesia, Physiotherapy and Knee
      reconstruction are expected to realize this goal.
    

Detailed description: 
      Consecutive patients presenting for elective TKA at the General (Dr. Dervin) will be
      approached for enrollment.

      Dr Dervin will present the study to their patients who are appropriate for the study when
      first confirmed for joint replacement after clinic assessment. If the patient has indicated
      that they are interested, the surgeon will inform the research coordinator who will then
      continue the consenting process. The research coordinator will confirm patient's eligibility
      to ensure that all inclusion and no exclusion criteria are met. The study will be explained
      in detail to qualify patients and they will be provided with a copy of the consent form. The
      consent form will also provide a clause of confidentiality informing patient privacy. All
      questions will be answered. Patients may also talk to the investigators with any additional
      questions.

      Patients will be advised preoperatively about an accelerated path while in hospital that will
      share many attributes of the standard TOH care map,but with several additions, chosen to help
      reduce pain and hemarthrosis, both felt to be the major impediments to faster recuperation.

        1. Surgery will be performed with a muscle sparing subvastus approach, chosen because of
           evidenced decreased pain.

        2. Tranexamic acid ( 10 mg/kg) intravenously will be administered to further reduce blood
           loss at time of tourniquet deflation.

        3. The "Game Ready" cold - compression device will be used post operatively to help reduce
           pain and minimize swelling.

           .

      Timeline:

      Outcome data collection is expected to be completed by July 1, 2018 to allow for a minimum 6
      month follow up.

      Outcomes (Metrics):

      The outcome measures are provided and are summarized here.

        1. Length of stay: We will measure LOS for these patients as compared to a cohort that is
           comparable in demographics who are being treated concurrently on the service

        2. Analgesic use in hospital and at home (where pt will maintain a 28 day pain diary to
           record analgesics taken and quality of life recovery questions) to be captured with
           special interest to any opioid sparing effect

        3. Physiotherapy will measure the Physical parameters such as range of motion and
           quadriceps strength during stay and at discharge, 2 weeks , and 1 , 2 and 3 months

        4. Patient satisfaction questionnaire outcome: after 6 months to evaluate

        5. Health care resource requirement

             1. Physiotherapy visits

             2. Use of mobility aids duration

        6. Time to return to work where applicable

      Benefits to patient The benefits to the patient will be substantial by improving the pace of
      recovery with less physical burden and quicker achievement of goals and resumption of normal
      activity.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The first 20 patients (baseline) will be treated in hospital so we can gauge the potential
        of inpatient stay and our criteria will be refined. The next group of 20 (intermediate)
        will be geared toward overnight stay and finally the last 120 patients (full intervention)
        will be geared for same day discharge using the successful protocol already in place for
        unicompartment knee arthroplasty (UKA) at TOH.
      
Keywords: knee, joint