Yoeri Bemelmans

Chapter 10 158 Discussion The most important findings of the present study were that preselected patients who followed the outpatient knee arthroplasty pathway have comparable quality of life and PROMs as patients who followed the conventional pathway. Other studies showed that enhanced recovery pathways were as satisfying or even more satisfied compared to conventional pathways regarding the PROMS [19]. Increased PROMS were reported by Larsen et al. [11,20,21] at 3, 4 and 12 months postoperative. They reported that early mobilization, a nurse-led organization and optimisation of the preoperative education were a possible reason for these improved PROMs [11,20,21]. Our preoperative education and postoperative organization was unchanged. Therefore, a possible explanation for our results could be the strict patient selection criteria to select patients into one of the two clinical pathways. Besides, the results of Larson et al. were found after TKA in an enhanced recovery pathway [11,20,21], data after outpatient surgery are lacking. Hoorntje et al. [12] recently published their case-controlled study regarding the presence of symptoms of anxiety and depression, by means of the Hospital Anxiety and Depression Scale (HADS) in patients operated after UKA. They found that at the first postoperative day, the median HADS score was significantly (p=0.02) lower in the OS group compared to the ERP group and that patients in the OS group were significantly more satisfied (NRS satisfaction score, p=0.03) without any differences between both groups at 3-month follow-up [12] Pain relief and improved function are one of the principal aims of arthroplasty, thus it was expected that PROMs would improve significantly after knee arthroplasty. Due to aging and associated health issues, decreased selfrated health scores could be a logic consequence. However, the EQ-5D was still significantly better than the preoperative value but not different between both pathways. This shows that the possible problems associated with the knee arthritis alone, determine partially the overall health score. In the present study a wide range of PROMs were used to measure pre- and postoperative outcome after knee arthroplasty in preselected patients following ERP or OS. PROMs are a subjective measurement of clinical outcome after arthroplasty [22]. The used PROMs in this study did not capturing changes over time due to a lack of sensitivity to change of these scores [23]. Nonetheless, PROMs remain inherently subjective, prone to an individual’s interpretation and perception of function [22,24]. A more accurate and objective measure to validate patient clinical outcome after knee arthroplasty is highly sought. In addition to PROMs, acceleration-based gait analysis has been accepted as an objective measurement of functional and clinical outcome in arthroplasty patients [25]. Recent results have shown that the physical activity parameters of patients after TKA, following the outpatient surgery pathway, were similar to patients who followed the standard enhanced recovery pathway [13]. Acceleration-based gait analysis providesmore insight information rather