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The Knee Care Press

Weekly

Do you aspire to optimise all aspects of patient care? Then help is at hand!


New playbook to support the implementation of an evidence-based pathway optimisation philosophy1.


Healthcare costs are rising globally – including a greater demand for joint replacements due to increasing life expectancy2. Healthcare professionals are expected to achieve more with less. Fast-track protocol implementation is a cost-effective strategy for patients undergoing joint replacement, associated with substantial quality-adjusted life years improvements and reduced costs2.

This new white paper addresses important features of fast-track total knee arthroplasty (TKA) processes and clinical approaches. It aims to provide an overview on where to focus, which clinical enhancements to implement, and what the barriers to improvement are. It also provides a clinical summary of the evidence base for the recommendations1.

Hospitals already aim to provide affordable and efficient access to treatment while maintaining the quality of orthopaedic care and improving clinical outcomes. But new approaches are needed to truly optimize efficiency and productivity without neglecting the quality of clinical results. Hospitals in Europe that follow an advanced recovery program for their patients achieve statistically significant savings of around 20% in costs per procedure, compared with a standard clinical pathway3, 4. Furthermore, patients who follow the pathway and accelerated processes experience a notable increase in satisfaction and quality of life after discharge versus standard care3, 4.

This new resource1 presents an evidence based consensus on important features of fast-track total knee arthroplasty (TKA) processes and clinical approaches. It is broken down into pre-operative, perioperative and postoperative phases. The first section addresses pre-op optimisation, thromboembolic prophylaxis, and patient information and patient engagement apps. The second part includes perioperative pain management, the anaesthetic protocol and local infiltration analgesia, surgical factors and the implant, and tourniquets, blood management and drains. The post-op section covers delirium, sleep disturbances, nausea and vomiting, oral fluid and nutrition, and early mobilisation.

It also addresses the current needs and challenges to fast-track TKA, and the continuous improvements necessary to optimise the patient journey. These include:

  • Fast-track as a ‘gold’ standard; further improvement of analgesia and anesthesia protocols to reach the goal of a pain- and risk-free operation
  • Variation in length of stay (LOS) days in European countries and the interest in outpatient surgery
  • Team collaboration and not getting stuck in ‘new’ traditions – it’s more a philosophy than a program
  • Data on post-discharge activity level; adopting technology to move parts of the end-to-end patient continuum to the patient’s home via telemedicine, and in so doing reduce the number of visits needed to the hospital

For your copy of the white paper please use the “speak to a ZB representative” button.

  1. Rapid RecoveryTM White Paper 2021: 3374.1-EMEA-en-Issue Date 2021-02-03
  2. Jansen, J. A., et al. A cost-effectiveness analysis after implementation of a fast-track protocol for total knee arthroplasty. Knee. 2020; 27: 451-458.
  3. Büttner, M., et al. Economic analyses of fast track total hip and knee arthroplasty: a systematic review. European Journal of Orthopaedic Surgery & Traumatology. 2020; 30: 67-74.
  4. Larsen, K., et al. Cost-effectiveness of accelerated perioperative care and rehabilitation after total hip and knee arthroplasty. JBJS Am 2009; 91: 761-772

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