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Patient Risk Assessment and Optimization

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Rapid Recovery in Total Joint Arthroplasty

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Abstract

Total joint arthroplasty (TJA) is among the most common and successful orthopedic procedures. Significant advances in perioperative care have enabled rapid recovery, with mobilization hours after the procedure. Rapid recovery programs require a standardized, multidisciplinary approach to patient care. When successfully implemented, rapid recovery TJA is a safe, cost-efficient, and patient-friendly strategy resulting in decreased hospital lengths of stay, improved patient functional outcomes, and no increase in hospital readmission or complication rates. As the volume of patients undergoing rapid recovery TJA expands, it is critical to develop evidence-based protocols to avoid an increase in complications. This chapter describes the evaluation and treatment of potential surgical candidates and provides insight into factors necessary for a safe and successful transition to rapid recovery TJA, including patient selection and risk assessment, multidisciplinary care coordination, and standardization of perioperative and postoperative protocols.

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References

  1. Charnley J. Arthroplasty of the hip: a new operation. Lancet. 1961;277:1129–32.

    Article  Google Scholar 

  2. Aynardi M, Post Z, Ong A, Orozco F, Sukin DC. Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study. HSS J. 2014;10:252–5.

    Article  Google Scholar 

  3. Yates AJ, Kerr JM, Froimson MI, Della Valle CJ, Huddleston JI. The unintended impact of the removal of total knee arthroplasty from the center for Medicare and Medicaid services inpatient-only list. J Arthroplast. 2018;33:3602–6.

    Article  Google Scholar 

  4. Berger RA, Sanders SA, Thill ES, Sporer SM, Della Valle C. Newer anesthesia and rehabilitation protocols enable outpatient hip replacement in selected patients. Clin Orthop Relat Res. 2009;467:1424–30.

    Article  Google Scholar 

  5. Berger RA, Jacobs JJ, Meneghini RM, Della Valle C, Paprosky W, Rosenberg AG. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res. 2004;429:239–47.

    Article  Google Scholar 

  6. Berger RA, Sanders S, Gerlinger T, Della Valle C, Jacobs JJ, Rosenberg AG. Outpatient total knee arthroplasty with a minimally invasive technique. J Arthroplast. 2005;20:33–8.

    Article  Google Scholar 

  7. Dorr LD, Thomas DJ, Zhu J, Dastane M, Chao L, Long WT. Outpatient total hip arthroplasty. J Arthroplast. 2010;25:501–6.

    Article  Google Scholar 

  8. Kolisek FR, McGrath MS, Jessup NM, Monesmith EA, Mont MA. Comparison of outpatient versus inpatient total knee arthroplasty. Clin Orthop Relat Res. 2009;467:1438–42.

    Article  Google Scholar 

  9. Berend KR, Lombardi AV, Mallory TH. Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients. Surg Technol Int. 2004;13:239–47.

    PubMed  Google Scholar 

  10. Berger RA, Kusuma SK, Sanders SA, Thill ES, Sporer SM. The feasibility and perioperative complications of outpatient knee arthroplasty. Clin Orthop Relat Res. 2009;467:1443–9.

    Article  Google Scholar 

  11. Stambough JB, Nunley RM, Curry MC, Steger-May K, Clohisy JC. Rapid recovery protocols for primary total hip arthroplasty can safely reduce length of stay without increasing readmissions. J Arthroplast. 2015;30:521–6.

    Article  Google Scholar 

  12. Toy PC, Fournier MN, Throckmorton TW, Mihalko WM. Low rates of adverse events following ambulatory outpatient total hip arthroplasty at a free-standing surgery center. J Arthroplast. 2018;33:46–50.

    Article  Google Scholar 

  13. Basques BA, Tetreault MW, Della Valle CJ. Same-day discharge compared with inpatient hospitalization following hip and knee arthroplasty. J Bone Joint Surg. 2017;99:1969–77.

    Article  Google Scholar 

  14. Starks I, Wainwright TW, Lewis J, Lloyd J, Middleton RG. Older patients have the most to gain from orthopaedic enhanced recovery programmes. Age Ageing. 2014;43:642–8.

    Article  Google Scholar 

  15. Richards M, Alyousif H, Kim J-K, Poitras S, Penning J, Beaulé PE. An evaluation of the safety and effectiveness of total hip arthroplasty as an outpatient procedure: a matched-cohort analysis. J Arthroplast. 2018;33:3206–10.

    Article  Google Scholar 

  16. Courtney PM, Froimson MI, Meneghini RM, Lee G-C, Della Valle CJ. Can total knee arthroplasty be performed safely as an outpatient in the medicare population? J Arthroplast. 2018;33:S28–31.

    Article  Google Scholar 

  17. Nelson SJ, Webb ML, Lukasiewicz AM, Varthi AG, Samuel AM, Grauer JN. Is outpatient total hip arthroplasty safe? J Arthroplast. 2017;32:1439–42.

    Article  Google Scholar 

  18. Bertin KC. Minimally invasive outpatient total hip arthroplasty. Clin Orthop Relat Res NA. 2005;435:154–63.

    Article  Google Scholar 

  19. Lavernia CJ, Villa JM. Rapid recovery programs in arthroplasty. J Arthroplast. 2015;30:533–4.

    Article  Google Scholar 

  20. Kelly MP, Calkins TE, Culvern C, Kogan M, Della Valle CJ. Inpatient versus outpatient hip and knee arthroplasty: which has higher patient satisfaction? J Arthroplast. 2018;33:3402–6.

    Article  Google Scholar 

  21. Teeny SM, York SC, Benson C, Perdue ST. Does shortened length of hospital stay affect total knee arthroplasty rehabilitation outcomes? J Arthroplast. 2005;20:39–45.

    Article  Google Scholar 

  22. Kim S, Losina E, Solomon DH, Wright J, Katz JN. Effectiveness of clinical pathways for total knee and total hip arthroplastyLiterature review. J Arthroplast. 2003;18:69–74.

    Article  Google Scholar 

  23. Weiser MC, Kim KY, Anoushiravani AA, Iorio R, Davidovitch RI. Outpatient total hip arthroplasty has minimal short-term complications with the use of institutional protocols. J Arthroplast. 2018;33:3502–7.

    Article  Google Scholar 

  24. Meding JB, Klay M, Healy A, Ritter MA, Keating EM, Berend ME. The prescreening history and physical in elective total joint arthroplasty. J Arthroplast. 2007;22:21–3.

    Article  Google Scholar 

  25. Callaghan JJ, Pugely A, Liu S, Noiseux N, Willenborg M, Peck D. Measuring rapid recovery program outcomes: are all patients candidates for rapid recovery. J Arthroplast. 2015;30:531–2.

    Article  Google Scholar 

  26. Goldstein DT, Durinka JB, Martino N, Shilling JW. Effect of preoperative hemoglobin A(1c) level on acute postoperative complications of total joint arthroplasty. Am J Orthop (Belle Mead NJ). 2013;42:E88–90.

    Google Scholar 

  27. Lieberman JR, Heckmann N. Venous thromboembolism prophylaxis in total hip arthroplasty and total knee arthroplasty patients. J Am Acad Orthop Surg. 2017;25:789–98.

    Article  Google Scholar 

  28. Courtney PM, Rozell JC, Melnic CM, Lee G-C. Who should not undergo short stay hip and knee arthroplasty? Risk factors associated with major medical complications following primary total joint arthroplasty. J Arthroplast. 2015;30:1–4.

    Article  Google Scholar 

  29. Lovald S, Ong K, Lau E, Joshi G, Kurtz S, Malkani A. Patient selection in outpatient and short-stay total knee arthroplasty. J Surg Orthop Adv. 2014;23:2–8.

    Article  Google Scholar 

  30. Goyal N, Chen AF, Padgett SE, Tan TL, Kheir MM, Hopper RH, Hamilton WG, Hozack WJ. Otto Aufranc Award: a multicenter, randomized study of outpatient versus inpatient total hip arthroplasty. Clin Orthop Relat Res. 2017;475:364–72.

    Article  Google Scholar 

  31. Gromov K, Kjærsgaard-Andersen P, Revald P, Kehlet H, Husted H. Feasibility of outpatient total hip and knee arthroplasty in unselected patients. Acta Orthop. 2017;88:516–21.

    Article  Google Scholar 

  32. Meneghini R, Gibson W, Halsey D, Padgett D, Berend K, Della Valle CJ. The American Association of Hip and Knee Surgeons, Hip Society, Knee Society, and American Academy of Orthopaedic Surgeons position statement on outpatient joint replacement. J Arthroplast. 2018;33:3599–601.

    Article  CAS  Google Scholar 

  33. Meneghini RM, Ziemba-Davis M, Ishmael MK, Kuzma AL, Caccavallo P. Safe selection of outpatient joint arthroplasty patients with medical risk stratification: the “outpatient arthroplasty risk assessment score”. J Arthroplast. 2017;32:2325–31.

    Article  Google Scholar 

  34. Ziemba-Davis M, Caccavallo P, Meneghini RM. Outpatient joint arthroplasty—patient selection: update on the outpatient arthroplasty risk assessment score. J Arthroplast. 2019;34:S40–3.

    Article  Google Scholar 

  35. Kim KY, Feng JE, Anoushiravani AA, Dranoff E, Davidovitch RI, Schwarzkopf R. Rapid discharge in total hip arthroplasty: utility of the outpatient arthroplasty risk assessment tool in predicting same-day and next-day discharge. J Arthroplast. 2018;33:2412–6.

    Article  Google Scholar 

  36. Dowsey MM, Kilgour ML, Santamaria NM, Choong PF. Clinical pathways in hip and knee arthroplasty: a prospective randomised controlled study. Med J Aust. 1999;170:59–62.

    Article  CAS  Google Scholar 

  37. Sah A. Considerations for office and staff protocols for outpatient joint replacement. J Arthroplast. 2019;34:S44–5.

    Article  Google Scholar 

  38. DeCook CA. Outpatient joint arthroplasty: transitioning to the ambulatory surgery center. J Arthroplast. 2019;34:S48–50.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    R. Michael Meneghini & Leonard T. Buller

Authors
  1. R. Michael Meneghini
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  2. Leonard T. Buller
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Correspondence to Leonard T. Buller .

Editor information

Editors and Affiliations

  1. Northwell Orthopedic Institute, New York, NY, USA

    Giles R. Scuderi

  2. The Orthopaedic Center of New Jersey, Somerset, NJ, USA

    Alfred J. Tria

  3. Hospital for Special Surgery, New York, NY, USA

    Fred D. Cushner

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Meneghini, R.M., Buller, L.T. (2020). Patient Risk Assessment and Optimization. In: Scuderi, G., Tria, A., Cushner, F. (eds) Rapid Recovery in Total Joint Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-030-41223-4_7

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  • DOI: https://doi.org/10.1007/978-3-030-41223-4_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-41222-7

  • Online ISBN: 978-3-030-41223-4

  • eBook Packages: MedicineMedicine (R0)

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