Improvement of super early results of getting out of bed after total knee arthroplasty in elderly patients

doi:10.3877/ cma.j.issn.1674-134X.2024.06.018

Abstract

Abstract:

Objective

To analyze the effect of the quality improvement tool of the supply tube on the very early ambulating activity of the elderly after total knee arthroplasty.

Methods

A total of 122 elderly patients receiving RA-TKA from the Department of Orthopedics of the 920th Hospital of the Joint Logistics Support Force of PLA from March 2022 to April 2023 were conveniently sampled. Among them， 61 patients from March 2022 to September 2022 were not treated with the intervention of the supply circle quality improvement tool as the control group， and were given routine nursing and related health education.The observation group included 61 patients who used the tool intervention from October 2022 to April 2023.T test， Chi-square test and repeated analysis of variance were used to compare the rate of getting out of bed and the time of first ambulation time. Visual anaolgue scale （VAS） and Knee Society score （KSS） were performed at rest， during and after activity.

Results

The compliance rate of getting out of bed after surgery， the time of getting out of bed for the first time and the compliance rate of all types of getting out of bed were higher in the observation group than in the control group， with statistical significance （χ²=21.058， t=16.611， walking on ground≥10m χ²=8.396， bed to chair transfer χ²=11.517， standing at the bedside over five minutes χ²=9.210， all P＜0.05）. VAS score showed statistically significant differences in inter-group effect， intra-group effect and interaction effect（F=5041.267， 317.856， 10.749， all P＜0.001）.Simple effect analysis showed that VAS scores in the observation group were lower than those in the control group （F=10.680， 28.846， both P＜0.05）. KSS， KSS function scores，and range of motion of knee in observation group were significantly higher than those in control group （t=2.150，2.530， 14.489， all P＜0.05）.

Conclusion

The quality control circle quality improvement tool can improve the ultra-early ambulation rate of elderly patients after robot-assisted total knee arthroplasty， improve the active pain，shorten the first ambulation time after surgery， improve the joint range of motion， and promote the recovery of joint function.

Key words: Arthroplasty， Replacement， Knee, Aged, Early Ambulation, Management Quality Circles

Yan Bai, Min Jiang, Bidan Wang, Luqiao Pu, Ying Yuan, Yuan Yang, Jinxiu Duan, Qin Zhou, Qianjiao Yu, Xiaoyan Xu. Improvement of super early results of getting out of bed after total knee arthroplasty in elderly patients[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(06): 813-817.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/ cma.j.issn.1674-134X.2024.06.018

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2024/V18/I06/813

Figures/Tables 6

Figure 1 Nursing and patient linkage program of getting out of bed very early after total knee arthroplasty

Table 1 Comparison of general information between two groups

组别 Groups	例数 Case number	年龄［岁，（ $\bar{x}$ ±s）］ Age（year）	性别（男/女） Gender（male/female）	侧别（左/右） Side（left/right）	病因（例）Causes
组别 Groups	例数 Case number	年龄［岁，（ $\bar{x}$ ±s）］ Age（year）	性别（男/女） Gender（male/female）	侧别（左/右） Side（left/right）	骨关节炎 Osteoarthritis	创伤性关节炎 Traumatic arthritis	其他 Others	畸形 deformity
观察组Observation group	61	72±4	39/22	32/29	41	7	4	9
对照组Control group	61	72±5	34/27	31/30	39	8	9	5
统计值Statistical value		t=0.810	χ ²=0.853	χ ²=0.033		χ ²=3.813
P值		＞0.05	＞0.05	＞0.05		＞0.05

Table 1 Comparison of general information between two groups

组别 Groups	例数 Case number	年龄［岁，（ $\bar{x}$ ±s）］ Age（year）	性别（男/女） Gender（male/female）	侧别（左/右） Side（left/right）	病因（例）Causes
组别 Groups	例数 Case number	年龄［岁，（ $\bar{x}$ ±s）］ Age（year）	性别（男/女） Gender（male/female）	侧别（左/右） Side（left/right）	骨关节炎 Osteoarthritis	创伤性关节炎 Traumatic arthritis	其他 Others	畸形 deformity
观察组Observation group	61	72±4	39/22	32/29	41	7	4	9
对照组Control group	61	72±5	34/27	31/30	39	8	9	5
统计值Statistical value		t=0.810	χ ²=0.853	χ ²=0.033		χ ²=3.813
P值		＞0.05	＞0.05	＞0.05		＞0.05

Table 2 Ambulation time after operation of the two groups

组别 Groups	例数 Case number	术后超早期下床活动［例（%）］ Ultra-early ambulation after surgery［n（%）］	下床活动时间［h，（ $\bar{x}$ ±s）］ Ambulation time
观察组Observation group	61	48（78.7）	10±3
对照组Control group	61	23（37.7）	47±17
统计值Statistical value		χ ²=21.058	t=16.611
P值		＜0.001	＜0.001

Table 2 Ambulation time after operation of the two groups

组别 Groups	例数 Case number	术后超早期下床活动［例（%）］ Ultra-early ambulation after surgery［n（%）］	下床活动时间［h，（ $\bar{x}$ ±s）］ Ambulation time
观察组Observation group	61	48（78.7）	10±3
对照组Control group	61	23（37.7）	47±17
统计值Statistical value		χ ²=21.058	t=16.611
P值		＜0.001	＜0.001

Table 3 The compliance rate of various activity types of the two groups

组别 Groups	例数 Case number	平地行走≥10m［例（%）］ Walking on ground ≥10 m［n（%）］		完成床椅转移［例（%）］ Bed-chair transfer［n（%）］		床边站立≥5 min［例（%）］ Bedside standing over five minutes［n（%）］
组别 Groups	例数 Case number	达标Yes	未达标No	达标Yes	未达标No	达标Yes	未达标No
观察组Observation group	61	38（62.4）	23（37.7）	48（78.7）	13（21.3）	43（70.5）	18（29.5）
对照组Control group	61	22（36.1）	39（63.9）	30（49.2）	31（50.8）	26（42.6）	35（57.4）
χ ²值		8.396		11.517		9.210
P值		0.004		＜0.001		0.002

Table 4 VAS scores of the two groups at rest， At activity and after activity after operation

组别Groups	例数Case number	VAS评分VAS scores			F值	P值
组别Groups	例数Case number	静息时At rest	活动时At activity	活动后After activity	F值	P值
观察组Observation group	61	3.9±1.0	5.4±1.0^a	2.7±0.8^ab	170.556	＜0.001
对照组Control group	61	3.8±0.9	5.9±0.8^a	3.6±1.0^b	175.296	＜0.001
F值		0.038	10.680	28.846
P值		0.846	0.001	＜0.001
组间效应Intergroup effect		F=5041.267，P＜0.001
组内效应Intra-group effect		F=317.856，P＜0.001
交互效应Interaction effect		F=10.749，P＜0.001

Table 5 KSS and function scores and range of motion of knee after surgery of the two groups

组别Groups	例数Case number	KSS	KSS功能评分 KSS functional score	膝关节活动度［°，（ $\bar{x}$ ±s）］ Range of motion of knee
观察组Observation group	61	91±9	88±7	104±64
对照组Control group	61	92±9	88±7	854±84
t值		2.150	2.530	14.489
P值		0.034	0.013	＜0.001

Table 5 KSS and function scores and range of motion of knee after surgery of the two groups

组别Groups	例数Case number	KSS	KSS功能评分 KSS functional score	膝关节活动度［°，（ $\bar{x}$ ±s）］ Range of motion of knee
观察组Observation group	61	91±9	88±7	104±64
对照组Control group	61	92±9	88±7	854±84
t值		2.150	2.530	14.489
P值		0.034	0.013	＜0.001

References 13

［1］	陈曦，钱文伟，翁习生，等. 机器人辅助系统在关节置换手术中的应用［J/CD］. 中华关节外科杂志（电子版）， 2017， 11（ 6 ）：646-650.
［2］	Xia R， Zhai Z， Zhang J， et al. Verification and clinical translation of a newly designed “skywalker” robot for total knee arthroplasty： a prospective clinical study［J］. J Orthop Translat， 2021， 29： 143-151.
［3］	杨琳，杨志英. ERAS协会“髋/膝关节置换术围术期加速康复护理共识”解读［J］. 护理研究， 2021， 35（ 11 ）： 1881-1885.
［4］	周宗科，翁习生，曲铁兵，等. 中国髋、膝关节置换术加速康复——围术期管理策略专家共识［J］. 中华骨与关节外科杂志，2016， 9（ 1 ）： 1-9.
［5］	余新颜，阮仁芝，徐进，等. 曼彻斯特疼痛管理模式的护理干预在肩袖修补术后的应用价值［J］. 中国实用护理杂志， 2022， 38（ 16 ）： 1212-1217.
［6］	吴亚丽，殷昌祺，马富珍，等6品管圈在提高心脏开胸术后病人早期下床活动达标率中的应用［J］. 全科护理， 2020， 18（ 20 ）：2549-2553.
［7］	van Zelm R， Coeckelberghs E， Sermeus W， et al. Variation in care for surgical patients with colorectal cancer： protocol adherence in 12 European hospitals［J］. Int J Colorectal Dis， 2017， 32（ 10 ）： 1471-1478.
［8］	向娜，马玉芬，高娜，等. 加速康复外科理念下全膝关节置换患者术后早期下床活动现状调查［J］. 中国护理管理， 2018， 18（ 11 ）： 1544-1549.
［9］	Murphy L， Helmick CG. The impact of osteoarthritis in the United States： a population-health perspective： a population-based review of the fourth most common cause of hospitalization in U. S. adults［J］.Orthop Nurs， 2012， 31（ 2 ）： 85-91.
［10］	刘冬华，丁青，童莺歌，等. 山东省164所医院术后疼痛护理管理现状调查［J］. 中国护理管理， 2016， 16（ 8 ）： 1053-1056.
［11］	富君丽，徐晓红，沈爱华，等. 基于活动性疼痛评估的疼痛管理在妇科术后患者中的应用效果［J］. 国际护理学杂志， 2021， 40（ 23 ）： 4394-4398.
［12］	Raphael M， Jaeger M， van Vlymen J. Easily adoptable total joint arthroplasty program allows discharge home in two days［J］. Can J Anaesth， 2011， 58（ 10 ）： 902-910.
［13］	董佩龙，唐晓波，王健，等. 加速康复外科在全膝关节置换术中的随机对照研究［J/CD］. 中华关节外科杂志（电子版）， 2020，14（ 5 ）： 540-545.

[1]	Yinsong Sun, Dehua Wang, Lu Zhou, Yiting Lei, Jiaying Wei, Yao He, Mingfei Dong, Chen Zhao, Wei Huang, Ke Li. Early clinical outcomes of robot-assisted functional alignment and manual mechanical alignment in total knee arthroplasty [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(06): 709-719.
[2]	Yiyao Li, Jie Xu. Progress in remote total knee arthroplasty follow-up and knee joint function evaluation [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(06): 790-794.
[3]	Xiaoling Chen, Yonglie Zhong, Qiaoli Liu, Na Li, Zhiqi Zhang, Weiming Liao, Guiwu Huang. Risk prediction of delirium and cardiovascular complications after hip and knee surgeries in elderly patients [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(05): 575-584.
[4]	Cuiping Chen, Peijun Li, Jingrong Du, Qingmei Xie, Yining Xu, Shuyu Zhuo, Xiaofang Li. Application effect of internet plus home nursing service in elderly patients after total hip replacement [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(05): 676-681.
[5]	Jing Zeng, Dongdong Wu, Ming Shao, Zhenbo Fan, Zhiguo Wang, Peiyi Liu, Haifeng Lan. Perioperative effect of different surgical timing in elderly patients with hip fracture [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(04): 445-449.
[6]	Junxiao Ren, Luqiao Pu, Zhihao Wang, Hongxin Shi, Aifeng Liu, Baochuang Qi, Yongqing Xu, Chuan Li. Comparative study of clinical efficacy of robot-assisted total knee arthroplasty [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(04): 469-476.
[7]	Yalong Xu, Dong Gong, Xiaotao Chen. Research progress on advanced analgesia in total knee replacement surgery [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(04): 517-523.
[8]	Yingying Ding, Kai Song, Jiyan Jin, Hua Tian. Postoperative refined clinical nursing of robotic-assisted knee and hip arthroplasties [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(04): 553-557.
[9]	Zhijing Yuan, Jie Huang, Guoan He, Huiqiang Fang. Application of local block anesthesia with ropivacaine and dexmedetomidine in elderly patients undergoing laparoscopic tension-free inguinal hernia repair [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(05): 557-561.
[10]	Bingcheng Meng, Hai Zhu, Hongbing Ren, Weimin Mao, Deling Wei, Banghao Xu, Jilong Wang, Zongrui Jin, Zhujing Lan, Keyu Huang, Tingting Lu, Ling Zhang, Ya Guo, Zhang Wen. Role of IGF-1-mediated FOXO signaling pathway in liver regeneration after ALPPS in rat models [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(01): 118-125.
[11]	Yue Zhao, Kun Tian, Zongming Zhang, Zhentian Guo, Limin Liu, Chong Zhang, Zhuo Liu. Predictive value of procalcitonin for incidence of acute severe cholecystitis in elderly patients [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 801-806.
[12]	Anli Hu, Jian Huang, Jianping Wang, Xiaopei Wang, Hongliang Chen, Hongyu Chen. The effect of phased application of fumigation and washing on the generation of granulation tissue on the wound of patients after anal fistula surgery [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2024, 13(05): 402-410.
[13]	Qian Zhang, Wei Tang, Lili Liu. Effect of dexmedetomidine combined with oxycodone on postoperative cognitive function and analgesic effect in elderly patients undergoing percutaneous endoscopic lumbar discectomy [J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(04): 209-214.
[14]	Ning Lu, Liyou Wei, Liang Li, Yulong Zhang. Analysis of factors associated with early recovery of wrist function after small splint treatment of distal radius fractures in the elderly [J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(04): 222-228.
[15]	Jian Cui, Qing Xia, Yun Lin, Guangling Li, Xinna Li, Wei Wang. Effects of platelet to lymphocyte ratio, immunoglobulin, myocardial enzyme spectrum and electrocardiogram parameters on the condition and prognosis of middle-aged and elderly patients with cirrhosis [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(05): 400-406.

Please choose a citation manager

Content to export