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

Study Overview
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Brief Summary
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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
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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.

Official Title
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Single-center Retrospective Study on Safety of Total Knee Replacement Surgery Before and After the Implementation of Enhanced Recovery Program

Conditions
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Arthroplasty Complications

Intervention / Treatment
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* Procedure: Enhanced recovery program


Participation Criteria
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Eligibility Criteria
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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: revision arthroplasty patients who refused to the use of their data

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Traditional method of care<br>Patients managed according to the traditional care protocol without an enhanced recovery program | |
| Some elements of a fast-track program<br>operative and postoperative techniques were modified according to a fast-track program | Procedure: Enhanced recovery program<br>* Enhanced recovery programs are a multimodal approach to optimize patients' physiological and psychological states in the preoperative, intraoperative and postoperative care domains.<br>|
| Full enhanced recovery program<br>Patients were managed in an enhanced recovery program (elements of the previous fast-track program were modified and preoperative education was added) | Procedure: Enhanced recovery program<br>* Enhanced recovery programs are a multimodal approach to optimize patients' physiological and psychological states in the preoperative, intraoperative and postoperative care domains.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Patients With Early Complication | 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. | 3 months after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Patients With Late Complication | 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. | up to 28 months after surgery | 
| Length of Hospital Stay | the time between admission for an operation and discharge from the hospital | up to 1 month after surgery | 
| Preoperative Knee Extension | Measure in degree of how much the knee straightens during consultation with surgeon | up to 1 month before surgery | 
| Postoperative Knee Extension | Measure in degree of how much the knee straightens during consultation with surgeon | At 3 months after surgery | 
| Preoperative Knee Flexion | Measure in degree of how much the knee bends during consultation with surgeon | up to 1 month before surgery | 
| Postoperative Knee Flexion | Measure in degree of how much the knee bends during consultation with surgeon | At 3 months after surgery |