scholarly journals Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations

2019 ◽  
Vol 91 (1) ◽  
pp. 3-19 ◽  
Author(s):  
Thomas W Wainwright ◽  
Mike Gill ◽  
David A McDonald ◽  
Robert G Middleton ◽  
Mike Reed ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Total Hip Replacement ◽  
Knee Replacement ◽  
Perioperative Care ◽  
Hip Replacement ◽  
Consensus Statement ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Replacement Surgery ◽  
Total Knee

scholarly journals Total Hip Replacement and Total Knee Replacement outcomes in the elderly - An opportunity for further improvement of ERAS pathways.

2020 ◽  
Author(s):  
Louise Burgess ◽  
Thomas Wainwright
Keyword(s):  
Length Of Stay ◽  
Total Knee Replacement ◽  
Elderly Patients ◽  
Total Hip Replacement ◽  
Knee Replacement ◽  
Hip Replacement ◽  
Enhanced Recovery ◽  
The Elderly ◽  
Very Elderly ◽  
Total Knee

Introduction Postoperative outcomes of total hip replacement (THR) and total knee replacement (TKR) have been improved by Enhanced Recovery after Surgery (ERAS) guidelines. The elderly population is increasing and successful fast-track rehabilitation can be achieved amongst this cohort. However, the cohorts studied in previous literature are generally younger, healthy patients, who would be expected to recover well from a multidisciplinary pathway. Literature to assess the role of enhanced recovery in the very elderly is limited. The aim of this study is to assess the current outcomes for elderly patients post THR and TKR and explore the opportunity for further application of ERAS pathways. Methods This retrospective study was completed by collecting UK acute NHS hospital data through Hospital Episode Statistics (HES), accessed via the Dr. Foster Healthcare Intelligence Portal. Length of stay, readmission rates, complication of care and mortality were recorded for all THR and TKR cases. Results Length of stay, readmission and complication of care rates increased linearly with age for both THR and TKR patients. For over 85s, average length of stay was 5.0 and 4.5 days (THR and TKR respectively), 30 day re-admission was 9.4% and 9.9%, complication of care was 13.3% and 11.9% and mortality rate was 0.5% and 0.4%. Conclusions The very elderly have the most to gain from an ERAS programme but still have the longest stay in hospital and the greatest post-operative complications. Further work is required to determine how to reduce the risk of complications and increase functional recovery in elderly patients.

scholarly journals Increased Incidence of Total Knee Replacement Surgery in Patients With Psoriasis: A Secondary Cohort Analysis of a Nationwide, Population-Based Health Claims Database

2021 ◽  
Vol 8 ◽  
Author(s):  
Ming-Chi Lu ◽  
Kuo-Sheng Fan ◽  
Chia-Wen Hsu ◽  
Malcolm Koo ◽  
Ning-Sheng Lai
Keyword(s):  
Total Knee Replacement ◽  
Total Hip Replacement ◽  
Knee Replacement ◽  
Hip Replacement ◽  
Knee Replacement Surgery ◽  
Total Hip ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Total Knee Replacement Surgery ◽  
Total Knee

Patients with rheumatic diseases, such as rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus, have increased risk of receiving total knee replacement surgery or total hip replacement surgery. We speculated that psoriasis could also attack the joints of the knees and hips, leading to an increased risk of receiving total knee replacement surgery or total hip replacement surgery. The aim of this study was to investigate the risk of total knee replacement or total hip replacement surgery in patients with psoriasis using a nationwide, population-based health claims database in Taiwan. Using the Taiwan's National Health Insurance Research Database, we identified 10,819 patients with psoriasis between 2000 and 2012. A comparison cohort consisting of five patients without psoriasis for each patient with psoriasis was assembled, based on frequency matching for sex, 10-year age interval, and index year. Both groups were followed until a diagnosis of the study outcomes (total knee replacement or total hip replacement surgery) or the end of the follow-up period. Incidence rate ratios (IRRs) for the outcome variables were calculated using multiple Poisson regression models. Female patients with psoriasis exhibited a significantly higher incidence of receiving total knee replacement surgery [adjusted IRR = 1.44, p = 0.014)]. Analyses stratified by age groups showed that the risk of receiving total knee replacement surgery was significantly higher older (adjusted IRR = 1.31, p = 0.047) patients with psoriasis. There were no significant differences in the risk of receiving total hip replacement surgery in patients with psoriasis compared with controls, either with or without stratification by sex or age groups. In conclusion, patients with psoriasis were associated with an increased risk of receiving total knee. Clinicians should be vigilant in assessing the presence of arthritis in these patients, and initiate strategies to delay or prevent the need for joint replacement.

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