Copyright
©The Author(s) 2022.
World J Orthop. Mar 18, 2022; 13(3): 307-328
Published online Mar 18, 2022. doi: 10.5312/wjo.v13.i3.307
Published online Mar 18, 2022. doi: 10.5312/wjo.v13.i3.307
Author/year | Procedure | Study design | Country/setting | ERP/regular pathway | Number participants ERP/regular pathway | Participants characteristics ERP/regular pathway | Outcome |
Arshi et al[42]; 2017 | TKA | Retrospective cohort | United States; Humana subset of the pearl-diver patient record database | Outpatient/inpatient | n = 133.342; 4.391/128.951 | Age: (70-74), modus 65-69; Men-women: (1.560-2.831)/(46.805-82.146) | LoS, (S)AE |
Auyong et al[36]; 2015 | TKA | Retrospective cohort | United States; Medical center | Updated ERAS/ERAS | n = 252; 126/126 | Age: 66.02 (10.02)/68.44 (9.98); Men-women: (44-82)/(41-85); BMI: 31.88 (7.629)/31.3 (6.562) | LoS, (S)AE, functional recovery, PROMs, readmission |
Basques et al[43]; 2017 | THA; TKA | Retrospective matched cohort | United States; NSQIP database | Same day/inpatient | n = 177.818, 1.236/176.582; THA: n = 63.360, 368/368; TKA: n = 110.410, 608/608; UKA: n = 4.048, 260/260 | Age: Most between 65-74; Men-women: (46.6%-53.4%)/(39.8%-60.2%); BMI: Most between 25-29.9 | LoS, (S)AE, readmission |
Bertin et al[26]; 2005 | THA | Pilot study, retrospectively chosen control group | United States; Hospital | Outpatient/existing protocol | n = 20; 10/10 | Age: 62/63; Men-women: (6-4)/(5-5); BMI: 30.024/29.64 | LoS, (S)AE, costs |
Bovonratwet et al[44]; 2017 | TKA | Retrospective cohort | United States; NSQIP database | Outpatient/inpatient | n = 112.922; 642/112.280 | Age: 64/67; Men-women: (265-377)/(41.821-70.459); BMI: 32/33 | LoS, (S)AE, readmission |
Bovonratwet et al[45]; 2017 | UKA | Cohort | United States; NSQIP database | Outpatient/inpatient | n = 5880; 568/5312 | Age: 62.9/63.7; Men-women: (284-284)/(2501-2811); BMI: 31.5/31.6 | LoS, (S)AE, readmission |
Brunenberg et al[27]; 2005 | THA; TKA | Before-after trial | Netherlands; University hospital | Joint recovery programme/usual care | n = 160; THA: n = 98, 48/50; TKA: n = 62, 30/32 | Age: 64.4 (28-87); THA: Age 63.38 (11.48)/ 65.4 (13.04), Men-women% (35.4-64.6)/(24-76); TKA: Age 64.9(9.43)/63.94 (12.6), Men-women % (33.3-66.7)/(31.3-68.7) | LoS, functional recovery; PROMs; costs |
Castorina et al[58]; 2017 | TKA | Retrospective observational cohort study | Italy; Orthopedics traumatology and rehabilitation unit | Fast track/traditional group | n = 132; 95/37 | Age: 71.1 (7.77)/74.62 (± 6.42) | Functional recovery; (S)AE |
Courtney et al[46]; 2017 | THA; TKA | Retrospective cohort | United States; NSQIP database | Outpatient/inpatient | n = 169.406; 1220/168.186 | Age: 63.1/65.9; Men-women: (539-681)/(67.687-100.499); BMI: 32.1/31.7 | LoS, (S)AE, readmission |
Courtney et al[59]; 2018 | TKA | Retrospective cohort | United States; NSQIP database | Outpatient/short stay/LOS ≥ 2 d | n = 49.136; 365/3033/45.738 | LoS, (S)AE, readmission | |
den Hertog et al[7]; 2012 | TKA | Randomized prospective study | Germany; Hospital | Fast-track group/standard care re-habilitation | n = 147 (ITT), 74/73; n = 140 (PP), 71/69 | Age: 66.58 (8.21)/68.25 (7.91); Men-women: (23-51)/(20-53); BMI: 31.17 (5.82)/30.38 (6.05) | LoS, (S)AE, functional recovery, PROMs |
Dowsey et al[28]; 1999 | THA; TKA | Prospective randomized controlled study | Australia; Tertiary hospital | Clinical pathway/control | n = 163; 92/71 | Age: 64.2/68.2; Men-women: 56/107 | LoS, (S)AE, functional recovery, readmission |
Featherall et al[60]; 2018 | THA | Cohort | United States; Clinic | Full protocol/transition cohort/Pre-protocol | n = 6090; 2081/2009/2000 | Age: 63.77 (11.72)/64.09 (12.04)/64.03 (12.09); Men-women: (1033-1048)/(983-1026)/(960-1040); BMI: 30.13 (6.17)/ 29.93 (6.19)/ 30.09 (6.38) | LoS, (S)AE, cost |
Gauthier-Kwan et al[61]; 2018 | TKA | Prospective comparative cohort | Canada; Hospital | Outpatient/inpatient | n = 86; 43/43 | Age: 62.5 (50.4-75), 62.5 (51.2-74); Men-women: (29-14)/(22-21); BMI: 28.6 (23.7-35.8)/30.4 (23.5-41.6) | LoS, (S)AE, readmission, functional outcome, PROMs |
Gooch et al[35]; 2012 | THA; TKA | RCT | Canada; Bone and Joint Health Institute | New clinical pathway/standard care | n = 1570, 1066 (THA: 615; TKA: 451)/504 (THA: 278; TKA: 226) | Age: 69 (11.1)/69 (10.4); Men-women%: (39.6-60.4)/(40.1-59.9); BMI: 29.5 (5.6)/29.4 (5.4) | (S)AE, functional recovery, PROMs |
Goyal et al[38]; 2017 | THA | Prospective randomized study | United States; Two reconstruction centres | Outpatient/inpatient | n = 220; 112/108 | Age: 59.8 (8.5) (59.3) (27-74)/60.2 (8.9) (61) (34-74); Men-women: (59-53)/(58-50); BMI: 27.6 (4.1) (27.1) (18-38.4)/ 28.3 (4.7) (27.7) (18.4-39.9) | LoS, (S)AE, readmission, functional recovery, PROMs |
Gwynne-Jones et al[47]; 2017 | THA; TKA | Matched cohort study | New Zealand; Hospital | Post ERAS/pre ERAS | n = 1035, 528/507; THA: 318/314; TKA: 210/193 | THA: Age 68.3 (11.8)/66.8 (11.8), Men-women (146-172)/(146-168); TKA: Age 70.4 (8.9)/69.8 (9.0), Men-women: 107-103/83-110 | LoS, (S)AE, readmission, PROMs |
Ho et al[30]; 2007 | TKA | Randomized controlled trial; retrospective cost analysis | United States; Tertiary teaching hospital | Critical pathway/no uniform CP | n = 90; 3 cohorts: 30/30/30 | Age: 66/67/68; Men-women: (14-16)/(14-16)/(14-16); Weight: 89/91/88 | LoS, (S)AE, costs |
Hoorntje et al[48]; 2017 | UKA | Case control study | Netherlands; Hospital | Outpatient/fast-track | n = 40; 20/20 | Age: 62.2 (5.5)/63.8 (7.5); Men-women: (10-10)/(7-13); BMI: 27.8 (3.7)/30.5 (7.0) | LoS, PROMs |
Huang et al[49]; 2017 | TKA | Prospective case control study | Canada; Tertiary academic medical centre | Same day discharge/inpatient | n = 40; 20/20 | Age: 58.5 (5.6)/61.5 (5.9); Men-women: (14-6)/(14-6); BMI: 29.0 (3.7)/30.6 (5.3) | LoS, (S)AE, readmission, cost |
Ismail A et al[39]; 2016 | TKA | Non-randomized control trial | Malaysia; University hospital | CP/control | n = 152; 73/79 | Age: 66.1/64.7 | LoS, (S)AE, readmission |
Jimenez Muñoz et al[29]; 2006 | THA | Prospective follow-up study | Spain; University general hospital | After CP/prior CP | n = 487; 384/98; 309/75 | Not present | LoS, (S)AE |
Klapwijk et al[50]; 2017 | THA | Prospective cohort | Netherlands; Hospital | Outpatient/inpatient | n = 94; 42/52 | Age: 61 (41-78)/68 (48-82); Men-women: (17-25)/(21-31); BMI: 29 (20-35) /26 (18-39) | LoS, (S)AE, functional recovery, PROMs |
Klingenstein et al[51]; 2017 | TKA | Retrospective cohort | United States; Joint replacement centre | Short stay/traditional stay | n = 2287; 1502/785 | Age: 71.7 (5.4)/73.3 (6.1); Men-women%: (39-61)/(25-75); BMI ≥ 30 (%): 50/57 | LoS, (S)AE, readmission |
Kolisek et al[31]; 2009 | TKA | Prospective matched cohort | United States; Hospital | Outpatient/conventional inpatient stay | n = 128; 64/64 | Age: 55 (42-64)/55 (42-63); Men-women: (40-24)/(40-24); BMI: 30.8 (24.3-38)/30.8(24.2-37.8) | LoS, (S)AE, functional recovery, PROMs, readmission |
Kort et al[3]; 2017 | UKA | Case control study | Netherlands; Hospital | Outpatient/rapid recovery | n = 40; 20/20 | Age: 60.5 (5.65)/61.2 (5.15); Men-women: (13-7)/(11-9); BMI: 29.1 (3.85)/27.7 (3.27) | LoS, (S)AE, readmission, PROMs |
Larsen et al[52]; 2017 | THA | Observational cohort | Denmark; Orthopedic clinic | Day case (< 12 h)/standard 2-d | n = 56; 20/36 | Age: 64.6; Men-women: 15-5; BMI: 28.8 (23.8-33.7) | LoS, (S)AE, readmission, PROMs |
Lovecchio et al[40]; 2016 | THA; TKA | Propensity score matched study | United States; NSQIP database | Outpatient/fast-track inpatients | n = 1968, 492/1476; THA/TKA: (183-585)/(309-891) | Age: Most between 60 to 69; Men-women: (217-275)/(664-812); BMI between 25-30 | LoS, (S)AE, readmission |
Maempel et al[41]; 2016 | THA | Prospective cohort | United Kingdom; Hospital | ERP/traditional rehabilitation | n = 1161; 550/611 | Age: 64 (18-94)/66 (23-90); Men-women: (212-338)/(242-369); BMI: 30 (7)/29 (7) | LoS, (S)AE, functional recovery, PROMs |
Maempel et al[37]; 2015 | TKA | Non-randomized prospective cohort | United Kingdom; Arthroplasty clinic | ERP/traditional rehabilitation | n = 165; 84/81 | Age: 69.8 (8.9)/70.1 (10.5); Men-women: (42-42)/(37-44); BMI: 32.4 (22.6-46.6)/31.8 (20.5-41.9) | LoS, (S)AE, functional recovery |
Malviya et al[34]; 2011 | THA; TKA | Observational study | United Kingdom; Hospital | ERP/traditional pathway | n = 4500; 1500 (THA: 630; TKA: 870)/3000 (THA: 1368; TKA: 1632) | Age: 68/69; Men-women: (711-789)/(1482-1518) | LoS, (S)AE, readmission |
Nelson et al[54]; 2017 | THA | Retrospective cohort, data prospectively collected | United States; NSQIP database | Outpatient/inpatient | n = 63.844; 420/63.424 | Age: 62/65; Men-women: (222-198)/(28.587-34.833); BMI most between 25-30 | LoS, (S)AE, readmission |
Pamilo et al[62]; 2018 | TKA | Retrospective cohort | Finland; Finnish Hospital Discharge Register | Fast-track CP/non-fast-track | n = 4256, 2310/1946; Hospital A: 624/437 | Age and sex: No statistically significant difference between CP’s | LoS, (S)AE, readmission |
Renkawitz et al[32]; 2010 | TKA | Prospective parallel group design | Germany; Orthopaedic university medical centre | Optimized accelerated CP/standard CP | n = 143; 67/76 | Age: 67 (9)/68.1 (11.1); Men-women: (14-53)/(23-53); BMI: 31.4 (5.1)/30.7 (5.6) | LoS, (S)AE, readmission, functional recovery |
Richter et al[55]; 2017 | UKA | Retrospective chart review | United States; Surgical outpatient center | Outpatient/inpatient | n = 22; 12/10 | Age: 67.2 (9.2)/64.5 (9.8); Men-women: (7-5)/(8-2); BMI: 28.7 (5.1)/25.8 (8.1) | LoS, (S)AE, readmission, cost |
Schotanus et al[69]; 2017 | TKA; UKA | Case control study | Netherlands; Hospital | Outpatient/ERP | n = 361; 94/267 | Age: 63.4 (8.0)/68.4 (9.0); Men-women: (49-45)/(94-173); BMI: 28.25 (3.68)/29.49 (5.05) | LoS, PROMs |
Toy et al[63]; 2018 | THA | Retrospective cohort | United States; Ambulatory surgery centers | Later outpatient pathway/initial outpatient pathway | n = 145; 72/73 | Age: 55 (27-70); Men-women: 76-49; BMI: 29.7 (19.6-43) | LoS, (S)AE, readmission |
Wilche et al[57]; 2017 | THA; TKA | Retrospective review | Spain; Hospital | Fast-track recovery/conventional recovery | n = 200; THA: 50/50; TKA: 50/50 | Age: 69.24 (9.64)/73.07 (8.33); Men-women: (40-60)/(40-60) | LoS, (S)AE, readmission, cost |
Author | Year | ERP | Preoperative | Peri-operative | Post-operative | ||||||||||||||||
Pre-opera | Peri-opera | Post-opera | Educa | Outpa | Dis | Physio | Pre-assess | Day of sur | Pre-medica | Opti | Neu | Mul | +/- peri arti | Avoid sur | Multi-modal analge | Day of surgery mobili | Venous throm | Reha | Early dis | ||
Arshi et al[42] | 2017 | X | X | ||||||||||||||||||
Auyong et al[36] | 2015 | X | X | X | X | X | X | X | X | X | |||||||||||
2017 | X | X | |||||||||||||||||||
2005 | X | X | X | X | X | X | X | X | |||||||||||||
2017 | X | X | |||||||||||||||||||
2017 | X | X | |||||||||||||||||||
2005 | X | X | X | X | X | ||||||||||||||||
2017 | X | X | X | X | X | ||||||||||||||||
2017 | X | X | |||||||||||||||||||
2018 | X | X | |||||||||||||||||||
2012 | X | X | X | X | X | ||||||||||||||||
1999 | X | X | |||||||||||||||||||
2018 | X | X | X | X | X | X | X | ||||||||||||||
2018 | X | X | X | X | X | X | X | X | X | ||||||||||||
2012 | X | X | X | X | X | X | X | X | X | X | X | ||||||||||
2017 | X | X | X | ||||||||||||||||||
Gwynne-Jones et al[47] | 2017 | X | X | X | X | X | X | X | X | X | X | ||||||||||
Ho et al[30] | 2007 | X | X | ||||||||||||||||||
2017 | X | X | X | X | X | X | |||||||||||||||
2017 | X | X | X | X | X | X | X | ||||||||||||||
2016 | |||||||||||||||||||||
2006 | X | X | X | ||||||||||||||||||
2017 | X | X | X | X | X | X | X | X | |||||||||||||
2017 | X | X | |||||||||||||||||||
2009 | X | X | X | X | X | ||||||||||||||||
2017 | X | X | X | X | X | X | X | X | X | ||||||||||||
2011 | X | X | X | X | X | ||||||||||||||||
2017 | X | X | X | X | |||||||||||||||||
2016 | X | X | |||||||||||||||||||
2016 | X | X | X | X | X | X | X | X | X | ||||||||||||
2015 | X | X | X | X | X | X | X | ||||||||||||||
2011 | X | X | X | X | X | X | X | X | |||||||||||||
2017 | |||||||||||||||||||||
2017 | X | X | |||||||||||||||||||
2018 | X | X | X | ||||||||||||||||||
2010 | X | X | X | X | X | X | X | X | |||||||||||||
2017 | X | X | |||||||||||||||||||
2017 | X | X | X | X | X | X | |||||||||||||||
2018 | X | X | |||||||||||||||||||
2017 | X | X | X | X | X | X | X | X | X | X | X |
Quality assessment | No. of patients | Effect | Quality | Importance | ||||||||
No. of studies | ||||||||||||
Design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | (S)AE | Control | Relative (95%CI) | Absolute | |||
Functional recovery (follow-up 24 mo) | ||||||||||||
12 | Randomised trials | No serious risk of bias | Serious1 | No serious indirectness | No serious imprecision | None | 0/2289 (0%) | 0/1802 (0%) | Not pooled | Not pooled | Moderate | Important |
0% | Not pooled | |||||||||||
PROMs (follow-up 24 mo; Better indicated by lower values) | ||||||||||||
15 | Randomised trials | No serious risk of bias | Serious2 | No serious indirectness | No serious imprecision | None | 2966 | 2388 | - | Not pooled | Moderate | Important |
LoS (follow-up 24 mo; Better indicated by lower values) | ||||||||||||
38 | Randomised trials | No serious risk of bias | No serious inconsistency | No serious indirectness | No serious imprecision | None | 997447 | 1573895 | - | MD 2.45 lower (3.42 to 1.48 lower) | High | Important |
(S)AEs | ||||||||||||
34 | Randomised trials | No serious risk of bias | No serious inconsistency | Serious3 | No serious imprecision | None | 2103/18344 (11.5%) | 83989/540864 (15.5%) | RR 0.91 (0.78 to 1.06) | 14 fewer per 1000 (from 34 fewer to 9 more) | Moderate | Important |
11.7% | 11 fewer per 1000 (from 26 fewer to 7 more) | |||||||||||
Readmission (follow-up 24 mo) | ||||||||||||
23 | Randomised trials | No serious risk of bias | No serious inconsistency | No serious indirectness | Serious4 | None | 273/9846 (2.8%) | 8360/406167 (2.1%) | RR 0.83 (0.65 to 1.07) | 3 fewer per 1000 (from 7 fewer to 1 more) | Moderate | Important |
2.7% | 5 fewer per 1000 (from 9 fewer to 2 more) |
- Citation: Heymans MJ, Kort NP, Snoeker BA, Schotanus MG. Impact of enhanced recovery pathways on safety and efficacy of hip and knee arthroplasty: A systematic review and meta-analysis. World J Orthop 2022; 13(3): 307-328
- URL: https://www.wjgnet.com/2218-5836/full/v13/i3/307.htm
- DOI: https://dx.doi.org/10.5312/wjo.v13.i3.307