Yoeri Bemelmans

Chapter 1 12 AIM of this thesis The studies of the present thesis were performed to analyse several aspects of the implementation of clinical pathway features, to improve outcome after hip and knee arthroplasty (part 1). Additional aims for this thesiswere to examine the safety and efficacy of the implementation of outpatient joint arthroplasty pathways into daily practice in a teaching hospital (part 2). Resulting in the following research questions: Part 1: Clinical pathway optimisation 1. Preoperative patient education: Are patients satisfied with the offered preoperative information? 2. Blood management: Does tranexamic acid reduce, in a safe manner, perioperative allogenic blood transfusions? 3. Pain management: Is local infiltration analgesia with ropivacaine alone at least equal effective compared to ropivacaine with adrenaline in themixture? 4. Urinarymanagement: Canwe omit standard usage of urinary catheters in primary hip and knee arthroplasty without causing increased postoperative urinary retention? Part 2: Outpatient joint arthroplasty 5. Outpatient unicompartimental knee arthroplasty: Is outpatient joint arthroplasty feasible for unicompartmental knee arthroplasty in a selected group of patients? 6. Evidence based practice and the literature: Are outpatient joint arthroplasty pathways safe and effective? 7. Patient selection: Which patients are eligible for outpatient joint arthroplasty? 8. Physical activity: How physically active are patients after outpatient surgery in their own environment compared to inpatient knee arthroplasty? 9. Quality of life: Does outpatient joint arthroplasty, compared to the standard inpatient joint arthroplasty, effect the improvement of patient reported quality of life after surgery? Outline of the thesis The presented studies in this thesis are divided into two parts; firstly the pre- and perioperative clinical optimisations and secondly the implementation of outpatient joint arthroplasty. Part one starts with a qualitative study regarding patients experiences on preoperative patient information and thus patients’ expectations. Management of these expectations after surgery directly influence postoperative outcomes and is therefore of major importance. Chapter 2 outlines the patients’ experiences on the usage of an information brochure handed out to knee arthroplasty patients.