Yoeri Bemelmans

Chapter 9 142 were able andwilling to follow instructions and return to the outpatient clinic for follow- up evaluations, were eligible for inclusion in the study. Patients with previous knee surgery (except for arthroscopic meniscectomy), active or recently treated infections and patients who were wheelchair-bound were excluded from the study. Included patients were not randomly selected for one of the two pathways, 10 patients followed ERP and 10 other patients followed the OS pathway [18]. There were no bilateral cases. Allocation of patients for the OS pathwaywas performed by the operating surgeon (NK) and based on the following criteria: no severe cardiologic, pulmonary and/or internal diseases, no additional treatment pre-, periand postoperative needed (e.g. medication adjustment in diabetes mellitus, bridging anticoagulation), patients can be discharged to home environment, able to understand and willing to participate in the OS pathway [18]. Pre-, peri- and postoperative protocols were previously described in detail [18]. A further optimisation of the RR pathway, as the standard pathway for arthroplasty, resulted in similar protocols regarding the use of dexamethasone and tranexamic acid within the conventional (ERP) andOS pathways in this study. Knee flexion as a discharge criterion is no longer applied. The differences between pathways are summarized in Table 1. The clinical reports and patient information were identical in both groups as well as the pain protocol [7]. No adrenaline was used during local infiltration analgesia (LIA) in the OS pathway, since it was shown that adrenaline could be omitted from the LIAmixture [32]. All TKA procedures were performed by one experienced knee surgeon (NK), performing a minimum of 150 TKA procedures annually. Patients were operated with the use of Patient Specific Guides (Signature, Zimmer Biomet, Warsaw, IN, USA) for the implantation of the cemented Vanguard CR TKA IN, USA). Baseline conditions and operative data are summarised in Table 2. Table 1. Differences between pathways pre-, peri- and postoperative care. ERP OS Preoperative Admission Night before/day of surgery Day of surgery Planned discharge <3 days postoperative Day of admission Perioperative Prophylactic antibiotics I.v. I.v. and oral Adrenaline in LIA mixture Yes No Postoperative First mobilization <6hrs <4hrs Compression bandages 24hrs postoperative 8hrs postoperative, first 4 days postoperative elastic bandage