After institutional review board and our DMF hospital ethical committee approval was obtained in accordance with Helsinki declaration, our institutional database was used to retrospectively identify 2 cohorts of consecutive patients who had undergone unilateral revision TKA with a single surgeon.
Patients who underwent surgery from January 2021 through July 2021 were included, as patients treated with revision TKA perioperative protocol, including use of tranexamic acid (1 g 30 minutes before incision), peri-capsular injection (0.2% ropivacaine at the end of procedure injected by surgeon), and inpatient physical therapy. Patients undergoing single-sided revision TKA under spinal anesthesia were included. Exclusion criteria included simultaneous bilateral TKA as single surgery, second-stage treatment for infection, or incomplete data recorded postoperatively.
All 40 patients in the retrospective study received a standard multimodal pain regimen including oral morphine, anti-emetics, and paracetamol, anti-inflammatory as ibuprofen unless contraindicated.
All patients received, in the perioperative stage, single shot of ACB or femoral consisting of 0.5% ropivacaine 20 ml without epinephrine performed by our regional anesthetists. Blocks were performed under ultrasound guidance. Anesthetic doses were based on patient body mass index (BMI) and age. These cohorts did not statistically differ in terms of gender, BMI, or Age and duration of surgery or anesthesia. (Table 1)
Table 1
|
Adductor group
|
Femoral group
|
P value
|
Age
|
66 (62-70)
|
70 (68-76)
|
0.98
|
Gender (female)
|
9/19
|
13/21
|
0.36
|
ASA
|
2 (2.1-2.6)
|
2 (2.5-2.7)
|
0.50
|
Duration of surgery (min)
|
142 (135-167)
|
155 (125-165)
|
0.34
|
BMI
|
29 (27-31)
|
30 (27-32)
|
0.69
|
Side of TKA (right)
|
12/19
|
14/21
|
0.82
|
Our surgeon is transitioned his practice to cemented components without tourniquet to all patients included in this study.
Retrospective chart review was then conducted to collect perioperative data for both groups. The data points of interest were quadriceps strength and patient's ability to walking meters and upstairs with physical therapy on postoperative day 1 (POD1), and postoperative in-hospital narcotic use in morphine equivalents per day (IV morphine mg per day). The criteria for discharge after TKA at our institution include pain adequately controlled on oral medications, tolerating a diet, voiding, and being cleared by physical therapy.
Criteria for clearing physical therapy include ability to perform antigravity leg lifts to display sufficient quadriceps strength, bed mobility with at most 25% assist with joints coach, and ability to ambulate 50 meters independently. Nurses, therapists, and case managers had no knowledge of the use of ACB peri-operatively and made all decisions on discharge criteria and pain medication administration.
Statistical analysis:
Analysis was performed on the 2 groups using independent sample t-tests, and chi-square analyses were used for categorical data where appropriate. P value of <.05 was set as the threshold to determine statistical significance of results. All statistical analyses were completed using JMP version 14.