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

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Abstract

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.

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Acknowledgments

The authors thank the other colleagues who participated in the data collection: Nicolas BONIN, Marc-Pierre HENRY, and Philippe TRACOL. The authors also thank Estelle VOYOT for extracting the data from the ATIH database.

Author information

Authors and Affiliations

  1. University Hospital Strasbourg, Pôle Locomax, 1 Avenue, Molière, 67200, Strasbourg, France

    Jean-Yves Jenny

  2. Hospices Civils de Lyon, 3 quai des Célestins, 69001, Lyon, France

    Cyril Courtin

  3. Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France

    Philippe Boisrenoult

  4. Clinique d’Argonay, 685 route des Menthonnex, 74370, Argonay, France

    Julien Chouteau

  5. Clinique Rhéna, 10 rue François Epailly, 67000, Strasbourg, France

    Pierre Henky

  6. Polyclinique des Trois Frontières, 8 rue Saint-Damien, 68300, Saint-Louis, France

    Claude Schwartz

  7. Clinique de l’Union, Boulevard Ratalens, 31240, Saint-Jean, France

    Aymard de Ladoucette

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  1. Jean-Yves Jenny
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  7. Aymard de Ladoucette
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Consortia

Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT)

Contributions

JYJ designed the study, monitored data collection, performed data analysis, drafted the manuscript, and wrote the final manuscript. CC performed literature analysis. ADL designed the study and monitored data collection. All authors performed data collection in their own center. All authors reviewed the drafted manuscript. All authors read and accepted the final manuscript.

Corresponding author

Correspondence to Jean-Yves Jenny.

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Conflict of interest

JYJ: Royalties from B-Braun, paid consultant for FH Orthopedics, member of board of CAOS-International and ISTA

CC: Nothing to disclose

PB: Paid consultant for Smith-and-Nephew and Zimmer

JC: Paid consultant for DePuy

PH: Nothing to disclose

CS: Paid consultant for FH Orthopedics

ADL: Paid consultant for Microport Orthopedics, member of board of SFHG

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Level of evidence: II (prospective comparative cohort study)

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Jenny, JY., Courtin, C., Boisrenoult, P. et al. Fast-track procedures after primary total knee arthroplasty reduce hospital stay by unselected patients: a prospective national multi-centre study. International Orthopaedics (SICOT) 45, 133–138 (2021). https://doi.org/10.1007/s00264-020-04680-0

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  • DOI: https://doi.org/10.1007/s00264-020-04680-0

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