Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2015, vol. 21, issue 3
Subject Area: Medicine - Orthopedics and Traumatology
Pages: 837-839
DOI: 10.5272/jimab.2015213.837
Published online: 03 August 2015

J of IMAB 2015 Jul-Sep;21(3):837-839
Pencho KosevCorresponding Autor, Tsvetan Sokolov, Ivalinka Pavlova, Boyan Valentinov, Jordan Andonov, Neli Petrova.
Department of Orthopedics and Traumatology, MHAT Ruse, Ruse, Bulgaria.

The number of orthopedic surgeons who are convinced in the need for significant changes in planned total knee arthroplasty (TKA) is increasing slowly and steadily. A new approach to pain control has been developed over the past 10-15 years, and the introduction of techniques to reduce perioperative stress, and the use of minimally invasive surgical techniques can help limit postoperative complications and shorten recovery time. This type of optimization is regarded as Fast-track Care program, where improved healing process is particularly useful to comorbid patients.  

Key words: fast-track care, local infiltration analgesia, multi-modal approach, total knee arthroplasty,

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Please cite this article in PubMed Style or AMA (American Medical Association) Style:
Kosev P, Sokolov T, Pavlova I, Valentinov B, Andonov J, Petrova N. Fast track surgery in total knee arthroplasty - A review. J of IMAB. 2015 Jul-Sep;21(3):837-839.

Correspondence to: Assoc. Prof. Pencho Kosev, MD, PhD, Department of Orthopedics and Traumatology, MHAT Ruse, Ruse, Bulgaria; 2, Nezavisimost  str., 7002 Ruse, Bulgaria; E-mail:

1. 1. Deirmengian CA, Lonner JH. What’s new in adult reconstructive knee surgery. J Bone Joint Surg Am. 2009 Dec;91(12):3008-18. [PubMed] [CrossRef]
2. Lloyd JM, Wainwright T, Middleton RG. What is the role of minimally invasive surgery in a fast track hip and knee replacement pathway? Ann R Coll Surg Engl. 2012 Apr;94(3):148–151. [PubMed]
3. Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop. 2008 Apr;79(2):174–183. [PubMed] [CrossRef]
4. Losina E, Thornhill TS, Rome BN, Wright J, Katz JN. The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic. J Bone Joint Surg Am. 2012 Feb;94(3):201-7. [PubMed] [CrossRef]
5. Raut S, Mertes SC, Muniz-Terrera G, Khanduja V. Factors associated with prolonged length of stay following a total knee replacement in patients aged over 75. Int Orthop. 2012 Aug;36(8):1601–1608. [PubMed] [CrossRef]
6. Kehlet H, Andersen LO. Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice. Acta Anaesthesiol Scand. 2011 Aug;55(7):778–84. [PubMed] [CrossRef]
7. Lee K, Goodman SB. Current state and future of joint replacements in the hip and knee. Expert Rev Med Devices. 2008 May;5(3):383-93. [PubMed] [CrossRef]
8. Hollowell J, Grocott MP, Hardy R, Haddad FS, Mythen MG, Raine R. Major elective joint replacement surgery: socioeconomic variations in surgical risk, postoperative morbidity and length of stay. J Eval Clin Pract. 2010 Jun;16(3):529-38. [PubMed] [CrossRef]
9. Scott CE, Bugler KE, Clement ND, MacDonald D, Howie CR, Biant LC. Patient expectations of arthroplasty of the hip and knee. J Bone Joint Surg Br. 2012 Jul;94(7):974-981. [PubMed] [CrossRef]
10. McDonald S, Page MJ, Beringer K, Wasiak J, Sprowson A. Preoperative education for hip or knee replacement. Cochrane Database Syst Rev. 2014 May 13;5:CD003526. [PubMed] [CrossRef]
11. Cila E, Guzel V, Ozalay M, Tan J, Simsek SA, Kanatli U, et al. Subvastus versus medial parapatellar approach in total knee arthroplasty. Arch Orthop Trauma Surg. 2002 Feb;122(2):65-68. [PubMed] [CrossRef]
12. Harwin SF. The medial parapatellar approach to the knee. J Knee Surg. 2003 Jan;16(1):43-47. [PubMed]
13. Minns Lowe CJ, Barker KL, Dewey M, Sackley CM. Effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis: systematic review and meta-analysis of randomised controlled trials. BMJ. 2007; 335:812. [CrossRef]
14. Berend KR, Lombardi AV Jr, Mallory TH. Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients. Surg Technol Int. 2004; 13:239-247. [PubMed]
15. Van Herck P, Vanhaecht K, Deneckere S, Bellemans J, Panella M, Barbieri A, et al. Key interventions and outcomes in joint arthroplasty clinical pathways: a systematic review. J Eval Clin Pract. 2010 Feb;16(1):39-49. [PubMed] [CrossRef]
16. Antrobus JD, Bryson GL. Enhanced recovery for arthroplasty: good for the patient or good for the hospital? . Can J Anaesth. 2011 Oct;58(10):891-6.  [PubMed] [CrossRef]
17. Macdonald V, Ottem P, Wasdell M, Spiwak P. Predictors of prolonged hospital stays following hip and knee arthroplasty. Intl J Ortho Trauma Nursing. 2010;14(4):198-205.
18. Schneider M, Kawahara I, Ballantyne G, McAuley C, Macgregor K, Garvie R, et al. Predictive factors influencing fast track rehabilitation following primary total hip and knee arthroplasty . Arch Orthop Trauma Surg. 2009 Dec;129(12):1585-91. [PubMed] [CrossRef]
19. Husted H, Jensen CM, Solgaard S, Kehlet H. Reduced length of stay following hip and knee arthroplasty in Denmark 2000-2009: from research to implementation. Arch Orthop Trauma Surg. 2012 Jan;132(1):101-4. [PubMed] [CrossRef]
20. Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty?. Acta Orthop. 2011 Dec;82(6):679-84. [PubMed] [CrossRef]
21. Jorgensen CC, Kehlet H. Role of patient characteristics for fast-track hip and knee arthroplasty . Br J Anaesth. 2013 Jun;110(6):972-80. [PubMed] [CrossRef]
22. Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006 Dec;203(6):865-77. [PubMed] [CrossRef]
23. Mallory TH, Lombardi AV Jr, Fada RA, Dodds KL, Adams JB. Pain management for joint arthroplasty: preemptive analgesia. J Arthroplasty. 2002 Jun;17(4 Suppl 1):129-133. [PubMed]
24. Andersen LO, Husted H, Otte KS, Kristensen BB, Kehlet H. A compression bandage improves local infiltration analgesia in total knee arthroplasty. Acta Orthop. 2008 Dec;79(6):806-811. [PubMed] [CrossRef]
25. Andersen LO, Husted H, Otte KS, Kristensen BB, Kehlet H. High-volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand. 2008 Nov;52(10):1331-1335. [PubMed] [CrossRef]
26. Yoon RS, Nellans KW, Geller JA, Kim AD, Jacobs MR, Macaulay W. Patient education before hip or knee arthroplasty lowers length of stay. J Arthroplasty. 2010 Jun;25(4):547-551. [PubMed] [CrossRef]
27. Bedekar N, Prabhu A, Shyam A, Sancheti K, Sancheti P. Comparative study of conventional therapy and additional yogasanas for knee rehabilitation after total knee arthroplasty. Int J Yoga. 2012 Jul;5(2):118-122. [PubMed] [CrossRef]
28. Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology. 2010 Aug;113(2):482-495. [PubMed] [CrossRef]
29. Holm B, Kristensen MT, Bencke J, Husted H, Kehlet H, Bandholm T. Loss of knee-extension strength is related to knee swelling after total knee arthroplasty. Arch Phys Med Rehabil. 2010 Nov;91(11):1770-1776. [PubMed] [CrossRef]
30. Essving P, Axelsson K, Kjellberg J, Wallgren O, Gupta A, Lundin A. Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty. Acta Orthop. 2010 Jun;81(3):354–360. [PubMed] [CrossRef]
31. Den Hertog A, Gliesche K, Timm J, Muhlbauer B, Zebrowski S. Pathway-controlled fast-track rehabilitation after total knee arthroplasty: a randomized prospective clinical study evaluating the recovery pattern, drug consumption, and length of stay. Arch Orthop Trauma Surg. 2012 Aug;132(8):1153-1163. [PubMed] [CrossRef]
32. Hollowell J, Grocott MP, Hardy R, Haddad FS, Mythen MG, Raine R. Major elective joint replacement surgery: socioeconomic variations in surgical risk, postoperative morbidity and length of stay. J Eval Clin Pract. 2010 Jun;16(3):529-38. [PubMed] [CrossRef].

Received: 07 April 2015
Published online: 03 August 2015

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