Fast-track procedures after primary total knee arthroplasty reduce hospital stay by unselected patients: a prospective national multi-centre study

• Published in: International orthopaedics Vol. 45; no. 1; pp. 133 - 138
• Main Authors: Jenny, Jean-Yves, Courtin, Cyril, Boisrenoult, Philippe, Chouteau, Julien, Henky, Pierre, Schwartz, Claude, de Ladoucette, Aymard
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2021
• Subjects: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee - adverse effects; France; Humans; Length of Stay; Medicine; Medicine & Public Health; Original Paper; Orthopedics; Patient Readmission; Prospective Studies; France; Total knee arthroplasty; Fast-track procedure
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-020-04680-0

Purpose The aim of this study was to evaluate the impact of fast-track procedures (FTPs) on length of hospital stay after primary total knee arthroplasty (TKA) in a prospective, national, multicentric analysis. The innovative point was that no patient selection was used. The hypothesis was that FTPs reduce hospital stay after primary TKA for non-traumatic conditions compared with the national database. Methods An observational prospective study was conducted in ten centres throughout France. A total of 839 patients included in FTPs were followed up for three months. The average LOS, direct return home rate, unscheduled re-admission rate, and re-intervention rate were compared with those in the national database (93,329 TKAs). Knee society and Oxford score were collected. Results The mean LOS was 4.4 ± 3.3 days, while the national base LOS was 6.4 ± 3.1 days ( p  < 0.001). A total of 560 patients (66.7%) were able to return home, compared with 47,617 (49.6%) in the national database ( p  < 0.001). Thirty-five patients (4.2%) were re-admitted within 90 days of the intervention, compared with 10,399 (10.8%) in the national database ( p  < 0.001). Seventeen patients (2.0%) were re-operated upon within 90 days after the TKA, compared with 529 (0.5%) in the national database ( p  < 0.05). Conclusion The FTPs used by unselected patients allowed a significant decrease in the mean LOS and in the rate of re-admission and a significant increase of the rate of direct home return after primary TKA compared with the national database. The significant increase in the re-operation rate warrants further investigation. However, FTP should become the standard of care after this intervention.