Clinical effect of total knee arthroplasty combined with enhanced recovery after surgery on knee osteoarthritis

Objective To evaluate the effect of total knee arthroplasty (TKA) combined with enhanced recovery after surgery (ERAS) in knee osteoarthritis (KOA). Methods Two hundred and twenty patients with KOA of the Department of Joint Surgery, Chifeng Municipal Hospital from January 2018 to November 2018 were divided into enhanced recovery group and control group according to the random number table method. The enhanced recovery group(n=108)was applied the ERAS concept and strictly implemented the enhanced recovery program. In contrast group, conventional surgical management mode was followed.Identical discharge standards were established for patients in two groups to evaluate the recovery time.The early postoperative pain numerical rating scale(NRS), blood transfusion rate, nausea and vomiting incidence, thirst, hunger and abdominal distension incidence rate, the time of discharge, the satisfaction of 2 weeks after operation, 3 months′ Hospital for special surgery(HSS) knee score after operation, and the incidence of postoperative complications were compared between the two groups. The data were analyzed by t test and chi-square test. Results At 12, 24, and 48 h after operation, the NRS score of patients in the enhanced recovery group were (2.13±1.21), (2.42±1.11), (2.83±1.18) points, which were lower than those in the control group[(3.24±1.45), (3.35±1.23), (3.78±1.25) points], the differences were statistically significant(t=3.9498, 3.7689, 3.7088; P=0.0002, 0.0003, 0.0004); postoperative blood transfusion rate was 6.5%(7/108) in the enhanced recovery group, it was considerably lower than the 27.7%(31/112) in control group, the difference was statistically significant(χ2=17.2887, P<0.05). The incidence of postoperative nausea and vomiting was 14.8%(16/108)in the enhanced recovery group, which was lower than that in the control group[38.4%(43/112)], the difference was statistically significant(χ2=15.5741, P<0.05). The rate of thirst and hunger in the enhanced recovery group was 12.0%(13/108), which was lower than that in the control group[41.1%(46/112)], the difference was statistically significant(χ2=23.6163, P<0.05). The average time for the enhanced recovery group to reach the discharge standard was (2.9±1.3) days, which was shorter than that of the control group[(5.7±1.6) days]. The difference was statistically significant(t=9.1301, P<0.05). The patients′ satisfaction degree at 2 weeks after operation in the enhanced recovery group was(9.8±1.2) points, which was higher than that of the control group[(8.9±1.1) points], the difference was statistically significant(t=3.7042, P<0.05). The HSS knee scores were (88.2±13.2), (87.7±16.6) points in the enhanced recovery group and control group at 3 months postoperatively, there was no significant difference between the two groups(t=0.1585, P=0.8744). The incidence of complications in the enhanced recovery group was 2.7% (3/108), which was lower than that in the control group[9.8% (10/112)], the difference was statistically significant(t=4.5779, P=0.0324). Conclusions ERAS in osteoarthritis of knee joint patients with TKA can reducing postoperative stress reaction, accelerate the recovery process of patients, reducing postoperative complications, shorten the lenth of hospital stay and effectively enhance the degree of satisfaction of the patients. It′s a safe and reliable choice and worthy to popularization and application in clinical. Key words: Rehabilitation; Arthroplasty, replacement, knee; Osteoarthritis, knee; Perioperative management