Yoeri Bemelmans

Chapter 12 180 The further development and usage of OJA pathways can only be justified if it doesn’t lead to increased complications and readmissions, which has been outlined in the previous chapters, but also maintains PROMs after surgery. Chapter 10 examined the PROMs after knee arthroplasty surgery between in- and outpatients by assessing health-related quality of life (EuroQol-5D) and functional outcome (Oxford Knee Score, Western Ontario and McMaster Universities Arthritis Index and the Pain-Numerical Rating Scale). A total of 361 consecutive patients undergoing knee arthroplasty (total and partial) who followed either the OJA pathway (n=94; 26.1%) or standard inpatient pathway (n=267; 73.9%) were analysed preoperative, and at 3 and 12-months follow up. At one year postoperative, patients in both pathways improved equally, which confirms that type of pathway does not influence PROMs, regarding quality of life or functional outcome, after knee arthroplasty surgery. In conclusion, this thesis provides several pre-, peri-, and postoperative protocols, which optimise current treatment strategies in hip and knee arthroplasty patients, elaborated in two parts describing fast-track and OJA protocols. Recommendation for future research ● High-quality trials (including randomized-controlled trials) comparing fast-track surgery with OJA. ● In-depth analysis and drafting of precise patient selection criteria for roll out OJA pathways to general orthopaedic practice in hip and knee arthroplasty surgery. ● Exploring the patients experience, perspective and recommendations for OJA pathways. ● Examination of the exact (non-)cost-effectiveness of OJA pathways.