Yoeri Bemelmans

Quality of life after outpatient and fast-track hip and knee arthroplasty 155 10 Introduction Modification of a selected number of literature-based protocols, used together, can be implemented in a care pathway. Such optimisation is also known as ‘outpatient joint arthroplasty’, a multimodal clinical pathway based on well-defined patient selection criteria [1-3] with the focus on discharge on the day of surgery while ensuring patients’ safety [1,4-8] and cost reduction [9,10,11]. Results have shown that quality of life after TKA, significantly improved within one year postoperative [11]. Although, these results were found after TKA in an enhanced recovery pathway, results during the early postoperative phase have shown that patients following the outpatient joint arthroplasty pathway were satisfied with sufficient physical activity [8,12,13]. Data on the quality of life after outpatient surgery on the long term are lacking. This is the first study to evaluate the quality of life during the long postoperative phase in patients undergoing knee arthroplasty following an outpatient surgery (OS) pathway compared to the standard enhanced recovery pathway (ERP) as measured with the EQ-5D and other patient reported outcome measures (PROMs). It was hypothesized that there would be no difference in quality of life between both pathways 1-yr after knee arthroplasty. Materials andMethods This comparative case study reviewed a consecutive series of patients (n=361) operated for knee arthroplasty (total and partial), with the use of patient specific instruments (Signature, Zimmer-Biomet, Warsaw INC) by one experienced knee surgeon (NK). Patients were operated between January 2014 and June 2015. Allocation of patients for the OS pathway or ERP was performed based on previous described selection criteria [14]. Pre-, peri- and postoperative protocolswere described in detail in previous study for OS [8]. A further optimisation of the ERP resulted in similar protocols, regarding the use of Dexamethasone, Tranexamic acid (both perioperative). Knee flexion as a discharge criterion is no longer applied. The differences between both pathways are summarized in Table 1.The clinical reports and patient information were identical in both groups as well as the pain protocol [8]. No adrenaline was used during local infiltration analgesia (LIA) in the OS pathway, since it was shown that adrenaline could be omitted from the LIA-mixture [14].