The constraints on day-case total knee arthroplasty: The fastest fast track
(2015) The Bone & Joint Journal — Vol. 97B, n° 10 Suppl A, p. 40-44 (2015)
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- (en) Total knee arthroplasty (TKA) is a major orthopaedic intervention. The length of a patient's stay has been progressively reduced with the introduction of enhanced recovery protocols: day-case surgery has become the ultimate challenge. This narrative review shows the potential limitations of day-case TKA. These constraints may be social, linked to patient's comorbidities, or due to surgery-related adverse events (e.g. pain, post-operative nausea and vomiting, etc.). Using patient stratification, tailored surgical techniques and multimodal opioid-sparing analgesia, day-case TKA might be achievable in a limited group of patients. The younger, male patient without comorbidities and with an excellent social network around him might be a candidate. Demographic changes, effective recovery programmes and less invasive surgical techniques such as unicondylar knee arthroplasty, may increase the size of the group of potential day-case patients. The cost reduction achieved by day-case TKA needs to be balanced against any increase in morbidity and mortality and the cost of advanced follow-up at a distance with new technology. These factors need to be evaluated before adopting this ultimate 'fast-track' approach.
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Thienpont, E., Lavand’homme, P., & Kehlet, H. (2015). The constraints on day-case total knee arthroplasty: The fastest fast track. The Bone & Joint Journal, 97B(10 Suppl A), 40-44. https://doi.org/10.1302/0301-620X.97B10.36610 (Original work published 2015)