Article

Our unit started to use routine multimodal techniques to
enhance recovery for hip and knee arthroplasty in 2008. We have previously
reported earlier discharge, a trend toward a reduction in complications, and a
statistically significant reduction in mortality up to 90 days after surgery. In this study, we evaluated the same cohort to determine whether survival benefits
were maintained at 2 years. Patients and methods We prospectively evaluated 4,500
unselected consecutive total hip and knee replacements. The first 3,000 underwent
a traditional protocol (TRAD) and the later 1,500 underwent an enhanced recovery
protocol (ER). Mortality data were collected from the Office of National
Statistics (UK). Results There was a difference in death rate at 2 years (TRAD
vs. ER: 3.8% vs. 2.7%; p = 0.05). Survival probability up to 3.7 years post
surgery was significantly better in patients who underwent an ER protocol.
Interpretation This large prospective case series of unselected consecutive
patients showed a reduction in mortality rate at 2 years following elective
lower-limb hip and knee arthroplasty following the introduction of a multimodal
enhanced recovery protocol. This survival benefit supports the routine use of an
enhanced recovery program for hip and knee arthroplasty.

Langue : ANGLAIS