Abstract
Purpose
Total and partial joint arthroplasty has been clinically proven to successfully relieve pain and improve function in patients with hip and knee degenerative arthrosis. It has been shown that early return to ambulation correlates well with functional scores. Moreover, the benefits of reduced narcotic use are multi-fold and range from reduced risk of addiction, gastrointenstinal and cardiopulmonary side effects. Establishing realistic pre-operative expectations regarding functional improvement and pain control will nevertheless impact patient satisfaction. Thus, the purpose of this study was to establish safe, achievable and data-driven benchmarks for post-operative ambulation and pain control in patients undergoing elective total joint arthroplasty.
Methods
A retrospective chart review was performed for of all patients who underwent elective primary total or partial joint replacement by a single fellowship trained academic joint replacement surgeon from 2/1/2015 to 2/29/16. Patients under the age of 18 as well as those who underwent arthroplasty to treat a traumatic injury or to revise an arthroplasty were excluded. Charts were reviewed for the method of ambulation (no ambulation, wheelchair, assistive devices, no devices) and use of prescription pain medications by 6 weeks post-operatively.
Results
82 patient undergoing elective primary arthroplasty were identified and included in the analysis. 38% of patients underwent TKA (31 of 82) and 62% of patients (51 of 82) underwent THA via the direct anterior approach. Post-operatively 63% (52 of 82) patients were ambulating without assist device. An additional 24% (20 of 82) of patients were ambulating with a single point assist device by 6 weeks. 77% (63 of 82) of patients were pain free by 6 weeks post operatively and denied taking any prescription pain medications.
Conclusions
Our analysis demonstrates that approximately 80% of patients undergoing elective total joint arthroplasty can be pain free without a need for prescription pain medication by 6 weeks post operatively. Moreover, while close to 90% of patients can expect to ambulate with at most, a single point assist, the majority (62%) can reliably expect to ambulate freely just 6 weeks after surgery. These results aid our understanding of post-operative return to function, and pain control. What is more, these data can inform a clinician in setting realistic, data-driven goals and expectations with patients undergoing elective total joint arthroplasty, thereby ultimately improving patient satisfaction with these commonly performed procedures.
