The Efficiency of the Patient Care Team on 3-Day Protocol for Early Ambulation after MIS-TKA
Pornchanok Nophakhun RN*, Atchara Yindee RN*, Piangduan Amornpiyakij RN*, Nipaporn Hlekmon RN*, Aree Tanavalee MD**
Affiliation : * Nursing Department, Saint Louis Hospital, Bangkok, Thailand ** Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Objective : To evaluate the efficiency of the patient care team on the 3-day protocol for early ambulation after minimally
invasive surgery-total knee arthroplasty (MIS-TKA)
Material and Method: A consecutive series of 120 episodes of patient’s admission for MIS-TKA in 103 patients, who were
taken care of by a single patient care team, was included in the present study. A uniform multimodal pain management and a
3-day rehabilitation protocol were applied. Patient’s demographic data, co-morbidities, pre- and postoperative pain, and
patient’s voluntary early ambulation following the 3-day protocol were evaluated. Patients who accomplished the 3-day
protocol were defined as having progress in postoperative ambulation, ability to do basic activities of daily living (ADL) and
able to comfortably walk on postoperative day 3 (POD 3).
Results : Patient’s mean age was 67.5 years and 68% (70/103) of patients had medical co-morbidities. After surgery, serial
mean pain scores from six hours to the day of discharge in the studied group were < 3. The 3-day protocol had an overall
success rate of 89% (107/120) regardless of medical co-morbidities. However, 32% of cases that had accomplished this
protocol extended hospital stay due to non-medical reasons. Among 13 patients who were unable to accomplish the 3-day
protocol, higher rate was found in patients who had > 1 medical co-morbidities. Comparing between unsuccessful and
successful groups, there was a significantly increasing rate of unsuccessful protocol in patients who had > 1 medical co-
morbidities (69.2% vs. 31.8%; p, < 0.05). There was no complication or readmission related to the early discharge program.
Conclusion : The result of 3-day protocol handled by the patient care team for MIS-TKA was highly efficient without
complications related to early ambulation. However, this early ambulation protocol may not be appropriate for patients who
have multiple medical co-morbidities. Besides the role of the patient care team, the efficiency of postoperative ambulation
protocol was additionally relied on surgeon’s experience in the surgical technique and effective multimodal postoperative pain
control.
Keywords : Minimally invasive surgery, MIS, Total knee arthroplasty, TKA, Rehabilitation, Protocol, Early, Ambulation, Patient care team
