Key result
A systematic review of 25 aspects of care for elective hip and knee replacement yielded recommendations for 16 areas, though overall evidence quality was deficient.
Why the study?
What is the evidence for different interventions in the preoperative, perioperative, and post-operative care for people undergoing elective total hip and knee replacement surgery?
Systematic Review
What is the evidence for different interventions in the preoperative, perioperative, and post-operative care for people undergoing elective total hip and knee replacement surgery?
There is a lack of high-quality evidence supporting many aspects of the continuum of care for primary THR/TKR surgery, limiting specific clinical recommendations.
Low-quality evidence limits firm clinical recommendations for hip and knee replacement care; leaves open critical gaps requiring future high-quality trials.
BACKGROUND: The objective of this study was to evaluate the evidence for different interventions in the preoperative, perioperative and post-operative care for people undergoing elective total hip (THR) and knee (TKR) replacement surgery. METHOD: A multidisciplinary working group comprising consumers, managers and clinicians from the areas of orthopaedics, rheumatology, aged care and rehabilitation evaluated randomized controlled trials (RCTs) and systematic reviews/meta-analyses concerning aspects of preoperative, perioperative and post-operative clinical care periods for THR/TKR through systematic searching of Medline, Embase, CENTRAL and the Cochrane Database of Systematic Reviews from May 2007 to April 2011. Multiple reviewers determined study eligibility and one or more members extracted primary study findings. The body of evidence were assessed and specific recommendations made according to NHMRC guidelines. RESULTS: Twenty-five aspects were identified for review. Recommendations for 16 of 25 areas of care were made: impact of waiting, multidisciplinary preparation, preoperative exercise, smoking cessation, interventions for comorbid conditions, predictors of outcome, clinical pathways, implementation of a blood management programme, antibiotic prophylaxis, regional anaesthesia and analgesia, use of a tourniquet in knee replacement, venous thromboembolism prophylaxis, early post-operative cryotherapy, early mobilization and continuous passive motion. In the post-operative period, study heterogeneity across all aspects of care precluded specific recommendations. CONCLUSIONS: There was a deficiency in the quality of the evidence supporting key aspects of the continuum of care for primary THR/TKR surgery. Consequently, recommendations were limited. Prioritization and funding for research into areas likely to impact clinical practice and patient outcomes after elective joint replacement surgery are the next important steps.
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Mak et al. (2013) conducted a systematic review in Elective total hip (THR) and knee (TKR) replacement surgery. Preoperative, perioperative and post-operative care interventions was evaluated on Evidence for different interventions in care. A systematic review of 25 aspects of care for elective hip and knee replacement yielded recommendations for 16 areas, though overall evidence quality was deficient.
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