Fast-track surgery and telerehabilitation protocol in unicompartmental knee arthroplasty leads to superior outcomes when compared with the standard protocol: a propensity-matched pilot study

Luca De Berardinis; Marco Senarighi; Carlo Ciccullo; Fabiana Forte; Marco Spezia; Antonio Pompilio Gigante

doi:10.1186/s43019-022-00173-z

Fast-track surgery and telerehabilitation protocol in unicompartmental knee arthroplasty leads to superior outcomes when compared with the standard protocol: a propensity-matched pilot study

Knee Surg Relat Res. 2022 Dec 12;34(1):44. doi: 10.1186/s43019-022-00173-z.

Authors

Luca De Berardinis¹, Marco Senarighi², Carlo Ciccullo², Fabiana Forte³, Marco Spezia⁴, Antonio Pompilio Gigante²

Affiliations

¹ Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy. luca8191deberardinis@gmail.com.
² Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy.
³ Specialist of Physical Medicine & Rehabilitation, COQ (Centro Ortopedico di Quadrante), Madonna del Popolo Hospital, Via Lungolago Buozzi 25, 28887, Omegna, VB, Italy.
⁴ Surgical Director of Department of Orthopaedics, COQ (Centro Ortopedico di Quadrante), Madonna del Popolo Hospital, Via Lungolago Buozzi 25, 28887, Omegna, VB, Italy.

Abstract

Background: Several strategies have been devised to reduce the length of stay after orthopedic surgery. Telerehabilitation has proved effective in functional outcomes after orthopedic procedures and is appreciated by patients. There is limited information on fast-track surgery and telerehabilitation protocols for unicompartmental knee arthroplasty (UKA). The purpose of this pilot study was to report and compare functional outcomes and satisfaction levels during first 12 months of recovery in patients who underwent UKA according to a fast-track and telerehabilitation protocol (G1) or standard surgery and rehabilitation program (G2).

Methods: Data were retrospectively collected and reviewed for all elective UKAs from January 2018 to November 2019. A total of seven patients undergoing UKA according to the fast-track and telerehabilitation protocol were propensity score matched (1:3 ratio) to 21 patients undergoing standard surgery and rehabilitation. Patients were matched for age, sex, body mass index (BMI), and laterality. The Western Ontario and McMaster University (WOMAC) osteoarthritis index and range of motion (ROM) were collected pre- and postoperatively in both groups for 12 months. In addition, patient' satisfaction was collected at 40 days.

Results: The G1 group demonstrated significantly better outcomes in WOMAC index scores at 2, 15, and 40 days (p < 0.001, p < 0.001, p < 0.020, respectively) and a significantly greater knee ROM after surgery and at 2, 15, 40, and 12 months (p < 0.001, p < 0.001, p = 0.014, p < 0.001, p = 0.003, respectively). No patients in either group had postoperative complications. One patient was not completely satisfied in the G2, while no one in G1 reported not being completely satisfied (p = 1.000).

Conclusions: This fast-track and telerehabilitation protocol after UKA can potentially be applied to patients as it is safe and effective. At 12-months follow-up, both groups reported favorable outcomes after UKA. However, the G1 score was better regarding WOMAC and ROM when compared with the propensity score-matched G2 program. A larger study is warranted to explore the role of fast-track and telerehabilitation in clinical and functional outcomes of UKA.

Keywords: Enhanced recovery after surgery; Fast-track program; Home rehabilitation; Knee arthroplasty; Telerehabilitation; Unicompartmental knee arthroplasty.