Content area
Full Text
Background
General practitioners play a vital and increasing part in the perioperative care of patients undergoing total knee replacement (TKR). Rising obesity rates, sports-related injuries and an ageing population are likely to result in a sharp increase in TKR procedures within the next decade, combined with higher cost concerns. Rehabilitation practices that show economic efficiency and produce superior patient outcomes are a major focus of current research.
Objective
The aim of this article is to provide an evidence-based summary of current rapid recovery protocols following TKR surgery.
Discussion
Rapid recovery protocols have been shown to be effective at reducing length of stay, postoperative pain and complications without compromising patient safety. These rapid recovery protocols include same-day mobilisation; blood preservation protocols; self-directed pedalling-based rehabilitation; and individualised targeted discharge to self-directed, outpatient therapist-directed or inpatient therapist-directed rehabilitation. Low-cost self-directed rehabilitation should be considered usual care, with inpatient rehabilitation reserved for the minority of at-risk patients.
THE BURDEN OF KNEE OSTEOARTHRITIS in Australia is projected to rise in response to an increase in the ageing population, obesity rates and sports-related injuries.1 Osteoarthritis now affects one in eleven Australian individuals2 and has been reported as the second most common diagnosis made by general practitioners (GPs) consulting with older patients.34 In accordance with the growth in prevalence of knee osteoarthritis, total knee replacement (TKR) surgery is also forecast to substantially increase in Australia, by up to 276% by 2030.1
TKR has been proven to be effective for improving a patients functional status and overall health quality, and it is widely regarded as a highly cost-effective intervention for end-stage knee osteoarthritis.5 GP input is vital in the continuum of care for the periods both before and after TKR surgery, particularly for communicating with patients about their expectations for TKR outcomes and rehabilitation. Knee rehabilitation practices have vastly evolved in the past decade, with many being associated with a paradigm shift from a traditional sick patient model of care to a well patient model.6 Advances in multimodal pain management, blood management and early mobilisation protocols all contribute to a rapid recovery pathway that has been proven to lower hospital length of stay without adversely affecting postoperative complications or readmissions.7 The aim of this narrative review is to provide a summary of...