Effect of enhanced recovery after surgery with multidisciplinary collaboration on nursing outcomes after total knee arthroplasty

BACKGROUND There is a lack of studies on the effects of enhanced recovery after surgery(ERAS)with multidisciplinary collaboration on the nursing outcomes of total knee arthroplasty(TKA).AIM To explore the effect of ERAS with multidisciplinary collaboration on nursing outcomes after TKA.METHODS We retrospectively analyzed the clinical data of 80 patients who underwent TKA at a tertiary hospital between January 2021 and December 2022.The patients were divided into two groups according to the nursing mode:the ERAS group(n=40)received ERAS with multidisciplinary collaboration,and the conventional group(n=40)received routine nursing.The following indicators were compared between the two groups:length of hospital stay,hospitalization cost,intraoperative blood loss,hemoglobin level 24 h after surgery,visual analog scale(VAS)score for pain,range of motion(ROM)of the knee joint,Hospital for Special Surgery(HSS)knee score,and postoperative complications.RESULTS The ERAS group had a significantly shorter length of hospital stay,lower hospitalization cost,less intraoperative blood loss,higher hemoglobin level 24 h after surgery,lower VAS score for pain,higher knee joint ROM,and higher HSS knee score than the conventional group(all P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).CONCLUSION Multidisciplinary collaboration with ERAS can reduce blood loss,shorten hospital stay,and improve knee function in patients undergoing TKA.

Virtual reality-based rehabilitation in patients following total knee arthroplasty:a systematic review and meta-analysis of randomized controlled trials

Background:Physical therapy is regarded as an essential aspect in achieving optimal outcomes following total knee arthroplasty(TKA).The coronavirus disease 2019(COVID-19)pandemic has made face-to-face rehabilitation inaccessible.Virtual reality(VR)is increasingly regarded as a potentially effective option for offering health care interventions.This systematic review and meta-analysis investigate VR-based rehabilitation's effectiveness on outcomes following TKA.Methods:From inception to May 22,2021,PubMed/Medline,Embase,Web of Science,the Cochrane Central Register of Controlled Trials,Scopus,PsycINFO,Physiotherapy Evidence Database,China National Knowledge Infrastructure,and Wanfang were comprehensively searched to identify randomized controlled trials(RCTs)evaluating the effect of VR-based rehabilitation on patients following TKA according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions.Results:Eight studies were included in the systematic review,and seven studies were included in the meta-analysis.VR-based rehabilitation significantly improved visual analog scale(VAS)scores within 1 month(standardized mean difference[SMD]:−0.44;95%confidence interval[CI]:−0.79 to−0.08,P=0.02),the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)within 1 month(SMD:−0.71;95%CI:−1.03 to−0.40,P<0.01),and the Hospital for Special Surgery Knee Score(HSS)within 1 month and between 2 months and 3 months(MD:7.62;95%CI:5.77 to 9.47,P<0.01;MD:10.15;95%CI:8.03 to 12.27,P<0.01;respectively)following TKA compared to conventional rehabilitation.No significant difference was found in terms of the Timed Up and Go(TUG)test.Conclusions:VR-based rehabilitation improved pain and function but not postural control following TKA compared to conventional rehabilitation.More high-quality RCTs are needed to prove the advantage of VR-based rehabilitation.As the COVID-19 pandemic continues,it is necessary to promote this rehabilitation model.

Rotational alignment in total knee arthroplasty： nonimage-based navigation system versus conventional technique

Background Proper rotational alignment during total knee arthroplasty （TKA） is important for adequate postoperative patellofemoral and tibiofemoral kinematics,as well as for achieving balanced flexion space at 90°.The effects of computer navigation-assisted total knee replacement and conventional total knee arthroplasty on rotational alignment,mechanical axis,component position and clinical outcomes were compared.Methods Two methods were used in 82 patients and the rotation of the femoral and tibial components in the transverse plane,the combined rotation of the two components,the mismatch between them,and the mechanical axis of the lower limb were analyzed.All of these parameters were measured from postoperative radiographs and computed tomography images.Functional outcomes were compared at 6 weeks and 6 months postoperatively.Results Significant differences were found between the two techniques （P 〈0.05） in the following parameters：average rotation of the femoral component （（1.51±3.55）° vs.（-0.63±3.04）°）; combined rotation of the femoral and tibial components （2.85±4.07）° vs.（0.28±3.43）°）; and mismatch between the femoral and tibial components （（1.44±4.55）° vs.（-0.43±2.86）°）.Differences in the rotation of the tibial component were not statistically significant.The prevalence of outliers （malalignment 〉±3° intemal/external rotation） of the femoral component （31.7% vs.12.5%） and the tibial component （36.6% vs.15%） were significantly reduced when the navigation system was used （P〈0.05）.In addition,while patients in the navigation group had significantly better mechanical axis and functional outcomes at 6 weeks after surgery （P 〈0.05）,there was no significant difference between the two groups （P 〉0.05） with respect to functional outcomes at 6 months.Conclusion The navigation system exhibited higher accuracy than the conventional technique in the transverse and coronal plane,and provided better early functional outcomes.

Application of Continuous Proximal Sciatic Nerve Blockade in the Treatment of Flexion Contractures After Primary Total Knee Arthroplasty

The main objective of total knee arthroplasty （TKA） is to relieve pain and restore normal knee function while providing stability through the gait cycle. However, postoperative flexion contracture can lead to suboptimal overall results.

Comparison of the clinical and radiological outcomes following midvastus and medial parapatellar approaches for total knee arthroplasty： a meta-analysis

Background Controversy still exists regarding whether medial parapatellar approach （MP） or midvastus approach （MV） is preferable in total knee arthroplasty （TKA） up to now.The aim of this meta-analysis was to compare the clinical and radiological outcomes following the MV or MP for TKA.Methods A comprehensive search of unrestricted-language literature of all studies comparing MP with MV was conducted through the electronic literature databases of PubMed,EMBASE,Cochrane Library,CNKI,VIP,and WANFANG.Retrieval time was from the time when databases were built to October 2013.Manual search of relevant trials,reviews,and related articles was also performed.Outcomes of interest included postoperative knee extensor and flexor function,postoperative pain,patella tilt,and complications.Relative risk （RR） and weighted mean differences （WMD） from each trial were pooled using random-effects or fixed-effects model depending on the heterogeneity of the included studies.A subgroup analysis or a sensitivity analysis was conducted to explore the potential source of heterogeneity when necessary.Results Twenty-one randomized controlled trials （RCTs） comprising 1 188 patients （1 450 knees） were eligible.Our results showed that MV was associated with better early postoperative extension （WMD=-1.26,95% CI-2.36 to-0.16,P=0.02） and flexion （WMD=10.13,95% CI 5.36 to 14.90,P 〈0.01）,less postoperative pain （WMD=-0.21,95% CI-0.34 to-0.07,P=0.002）,and no greater risk for complications than MP.The patella tilt did not differ significantly between the two groups （WMD=-0.70,95% CI-1.94 to 0.54,P=0.27）.Conclusions MV may be a better approach than MP,as it improves postoperative early joint function and decreases oain.Future multi-center randomized controlled studies with large sample sizes are required to verify the current findings.