Yoeri Bemelmans

Outpatient unicompartimental knee arthroplasty 79 6 Patients received preoperative education and exercise training, to become familiar with walking (stairs) with crutches and transfers from bed to a chair and vice versa, information about the in- and outpatient process and home-based rehabilitation. All surgeries were performed with the use of patients specific pin guides (Signature, Biomet, Warsaw INC) and tourniquets by a single experienced knee arthroplasty surgeon (NK). Patients received the (un-) cemented Oxford phase III UKA (Biomet, Bridgend, UK). Prophylactic antibiotics (2g Cefazoline) were administered 30 minutes (min) before incision. A second dose (1gCefazoline) was administered before discharge. The third dose (300mg Cedax) was taken orally the first postoperative morning at home. Patients were operated under general or spinal anesthesia. Local infiltration analgesia (LIA) was used intraoperative according to Kerr and Kohan [21]. In order to prevent PONV, dexamethasone was used intraoperative (8mg i.v.). Tranexamic acid (dose: 1g if weight <100kg, 1,5g if weight >100kg) was provided intravenously at wound closure. No drains or urinary catheters were used. Urinary retention was tested with the use of a bladder scan (Verathon®, BVI 9400). A compression bandage was used to reduce knee swelling [7] and to increase the effect of the LIA [1] during the first 8hrs postoperative and was removed before discharge. Cooling by ice packs, to cope with knee swelling, was advised within the first 24hrs postoperative. An optimised and opioid sparing-pain protocol was provided (Table 1). As rescue pain medication, Tramadol 50mg was administered (max. 2 times daily). If the patient still suffered from high pain intensity while still in hospital after Tramadol, 15mg of dipidolor was injected intramuscular (max. 6 times daily). Table 1. Optimised pain protocol. Preoperative Postoperative 2hrs 4hrs 8hrs First day Day 2-14 Arcoxia (mg) 90 90 90 Paracetamol (g) 1 1 1 1* 1* Gabapentine (mg) 600 300 300 Omeprazol (mg) 40 40 40 *One Paracetamol (1g) was given four times daily on fixed intervals throughout the day. The first mobilization was attempted within 4-6hrs postoperative, including transfer from the bed to a chair, standing and walking with a walker if possible. If necessary in their home-environment, walking stairs with crutches was practiced before discharge. Patients received instructions for self-administering subcutaneous syringes for thrombosis prophylaxis (Fondaprinux 2.5mg, Arixtra®, GlaxoSmithKline) administered once each evening for 35 days, starting at 22:00pm directly postoperative. After