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Abstract
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Background and Aims This review was undertaken to assess perioperative management and outcomes after primary total knee replacement.
Methods Retrospective data collection from 28 patients undergoing primary knee arthroplasty. Data collection included patient demographics, ASA, BMI, pre-operative opioid use, anaesthetic technique, tourniquet use, post-operative analgesia regime, assessment of pain and mobility on POD 1 and 3 and duration of post operative regional analgesia.
Results BMI and chronic opioid usage were lower than historical data numbers. 93% patients had single shot spinal, 82% underwent sedation and 18% had a GA. All patients had an adductor canal catheter sited with an infusion post operatively of 0.2% ropivacaine. 96% cases had surgical LIA of various volumes up to 100ml ropivacaine 0.2%. Average pain score at rest on POD 1 was 3.29, ranging from no pain (11%), to mild pain (71%), moderate (11%) and severe (7%). 57% could mobilise 5m on POD1. Pain scores increased on mobilisation with 32% reporting moderate and severe pain. By POD 3, 6 patients (21%) were already discharged. Of the remaining patients, 55% reported mild pain. 71% mobilised 20m on POD3. Pain scores on movement were predominantly moderate (50%) and severe (23%).
Conclusions 2023 results demonstrate exciting progress in total knee replacement perioperative care at Sir Charles Gairdner Hospital, with 21% of patients discharged home by POD 3. This may be as a result of improved patient selection for total knee replacement. The most common anaesthetic technique for TKR in our hospital is a single shot spinal with sedation and an adductor canal catheter.
Patient Demographics 2023 vs 2018
Ability to mobilise 5m POD 1 2023 vs 2018
Ability to mobilise 20m POD3, 2023 vs 2018