Exploration of refined clinical pathways in artificial joint replacement

doi:10.3877/cma.j.issn.1674-134X.2025.05.003

Abstract

Abstract:

Objective

To investigate the impact of refining the clinical pathway process and management training model for artificial joint replacement on medical efficiency, treatment outcomes, and the competency enhancement of resident physicians.

Methods

A total of 258 cases undergoing artificial joint replacementat Sun Yat-sen Memorial Hospital from June 2023 to June 2024 (experimental group) were included and subjected to a refined clinical pathway management model with hierarchical progressive diagnosis and treatment. These cases were compared with 201 cases managed under the traditional clinical pathway model by the same treatment team from June 2022 to May 2023. Inclusion criteria: patients undergoing primary unilateral total hip or knee arthroplasty. Exclusion criteria: revision surgery, multiple joint replacements, active infection, severe osteoporosis, neuromuscular disorders, and incomplete data.Independent samples t test and chi square test were used to compare hospital stay duration, costs, and complication rates between groups. Resident physicians in the experimental group followed the refined clinical pathway for clinical work and training, and their clinical competency improvement was compared with that of the control group.

Results

The experimental group exhibited significantly shorter hospital stays (t=3.061, P<0.05), lower costs (t=5.515, P<0.05), and reduced overall complication rates (χ²=6.592, P<0.05) compared to the control group. The clinical competency of resident physicians under the refined clinical pathway improved significantly (t=-17.174, P<0.001).

Conclusion

Refining the clinical pathway process enhances work efficiency and treatment outcomes, while also promoting the clinical competency of resident physicians.

Key words: Arthroplasty, replacement, Perioperative care, Clinical pathway, Internship and residency

Zhongkun Gou, Tanxiao Chen, Yiyao Li, Haohao Lei, Meiyi Chen, Deng Li, Jie Xu. Exploration of refined clinical pathways in artificial joint replacement[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(05): 535-542.

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Figures/Tables 6

References 20

[1]	Pivec R, Johnson AJ, Mears SC, et al. Hip arthroplasty[J]. Lancet, 2012, 380 （9855）: 1768-1777.
[2]	Price AJ, Alvand A, Troelsen A, et al. Knee replacement[J]. Lancet, 2018, 392 （10158）: 1672-1682.
[3]	Goyal S, Tandon T, Sangoi D, et al. Total joint replacement[M]//General Principles of Orthopedics and Trauma. Cham: Springer International Publishing, 2019: 429-489.
[4]	中华人民共和国民政部, 全国老龄办. 2023年度国家老龄事业发展公报[EB/OL]. （2024-10-11） [2025-02-05]. URL
[5]	胡银华,薛龙. 中国中老年人症状性膝骨关节炎的发病率及危险因素[J/OL]. 中华关节外科杂志（电子版）, 2023, 17（4）: 470-478.
[6]	边焱焱, 程开源, 常晓, 等. 2011至2019年中国人工髋膝关节置换手术量的初步统计与分析[J]. 中华骨科杂志, 2020, 40（21）: 1453-1460.
[7]	Avant-Garde Health and Codman Shoulder Society Value-Based Care Group, Khan AZ, O’DonnellEA, et al. A preoperative risk assessment tool for predicting adverse outcomes among total shoulder arthroplasty patients[J]. J Shoulder Elbow Surg, 2025, 34（3）: 837-846.
[8]	汪洋, 刘义超, 马骏. 全膝关节置换临床路径与效果分析[J]. 中国组织工程研究, 2015, 19（9）: 1340-1344.
[9]	陈镁仪, 许杰, 李登, 等. 形成性评价模式在骨科临床教学中的应用[J]. 中国继续医学教育, 2022, 14（21）: 109-114.
[10]	中华医学会骨科学分会关节外科学组, 解放军总医院第四医学中心骨科医学部, 国家骨科与运动康复临床医学研究中心. 中国膝骨关节炎非手术治疗专家共识（2023年版）[J/OL]. 中华关节外科杂志（电子版）, 2024, 18（02）: 151-159.
[11]	Askari M, Tam JY, Klundert J. The effectiveness of clinical pathway software in inpatient settings: a systematic review[J/OL]. Int J Med Inform, 2021, 147: 104374. DOI:10.1016/j.ijmedinf.2020.104374.
[12]	Chan TCY, Forster K, Habbous S, et al. Inverse optimization on hierarchical networks: an application to breast cancer clinical pathways[J]. Health Care Manag Sci, 2022, 25（4）: 590-622.
[13]	黄强, 廖刃, 冯沅, 等. 骨科手术加速康复围术期并存心血管疾病多学科评估与处理策略[J]. 中国骨与关节杂志, 2020, 9（10）: 723-729.
[14]	Jackman DM, Zhang Y, Dalby C, et al. Cost and survival analysis before and after implementation of Dana-farber clinical pathways for patients with stage IV non-small-cell lung cancer[J/OL]. J Oncol Pract, 2017, 13（4）: e346-e352. DOI:10.1200/JOP.2017.021741.
[15]	Nishikimi T, Nakagawa Y. Potential pitfalls when interpreting plasma BNP levels in heart failure practice[J]. J Cardiol, 2021, 78（4）: 269-274.
[16]	Puccetti F, Wijnhoven BPL, Kuppusamy M, et al. Impact of standardized clinical pathways on esophagectomy: a systematic review and meta-analysis [J/OL]. Dis Esophagus, 2022, 35（2）: doab027. DOI:10.1093/dote/doab027.
[17]	Wen C, Fan CH, Dong YY, et al. The application of critical pathway management to resident doctor’s standardized training in pediatrics[J]. Eur Rev Med Pharmacol Sci, 2017, 21（4 Suppl）: 120-125.
[18]	李丽, 丛馨, 吴立玲. 形成性评价在高等医学院校基础医学教育创新发展中的应用和启示[J]. 生理学报 2020; 72 （6）: 743-750.
[19]	Alkalash SH, Farag NA. Effect of workplace-based assessment utilization as a formative assessment for learning among family medicine postgraduates at the faculty of medicine, menoufia university: a prospective study[J/OL]. Cureus, 2023, 15（2）: e35246. DOI:10.7759/cureus.35246.
[20]	杨艳. 用教师有效反馈，提升形成性评价的教学效果和学生的主体作用[J]. 中国生物化学与分子生物学报, 2024, 40 （12）: 1771-1778.

项目Subjects	新模式组Experimental group	传统组Control group	统计值Statistical values	P值
例数Number of cases	258	201
年龄[岁，（±s）] Age (year)	66±12	65±13	t=0.900	>0.05
体重[kg，（±s）] Weight	64±10	63±11	t=0.124	>0.05
性别Gender [n（%）]
男Male	67（26.0）	66（32.8）	χ²=2.589	>0.05
女Female	191（74.0）	135（67.2）
手术方式[n（%）] Surgical technique
全膝关节置换Total knee replacement	156（60.5）	110（54.7）	χ²=1.791	>0.05
全髋关节置换Total hip replacement	102（39.5）	91（45.3）
基础病构成[n（%）]Spectrum of baseline comorbidities
肾功能异常Kidney disease	27（10.5）	27（11.8）	χ²=0.959	>0.05
心血管疾病Cardiovascular disease	22（8.5）	26（12.9）	χ²=2.345	>0.05
肢体血栓Venous thromboembolism	12（4.7）	6（3.0）	χ²=0.832	>0.05
其他Others	23（8.9)	25（12.4)	χ²=1.489	>0.05

项目Subjects	新模式组Experimental group	传统组Control group	统计值Statistical values	P值
例数Number of cases	258	201
年龄[岁，（±s）] Age (year)	66±12	65±13	t=0.900	>0.05
体重[kg，（±s）] Weight	64±10	63±11	t=0.124	>0.05
性别Gender [n（%）]
男Male	67（26.0）	66（32.8）	χ²=2.589	>0.05
女Female	191（74.0）	135（67.2）
手术方式[n（%）] Surgical technique
全膝关节置换Total knee replacement	156（60.5）	110（54.7）	χ²=1.791	>0.05
全髋关节置换Total hip replacement	102（39.5）	91（45.3）
基础病构成[n（%）]Spectrum of baseline comorbidities
肾功能异常Kidney disease	27（10.5）	27（11.8）	χ²=0.959	>0.05
心血管疾病Cardiovascular disease	22（8.5）	26（12.9）	χ²=2.345	>0.05
肢体血栓Venous thromboembolism	12（4.7）	6（3.0）	χ²=0.832	>0.05
其他Others	23（8.9)	25（12.4)	χ²=1.489	>0.05

分组Groups	例数Number of cases	急性肾功能异常Acute kidney injury	慢性肾功能异常加重Progression of chronic kidney disease	肢体血栓Venous thromboembolism	心血管事件Cardiovascular events	切口愈合不良Delayed wound healing	并发症Ccomplications
新模式组Experimental group	258	14（5.4）	84（32.6）	39（15.1）	36（14.0）	2（0.8）	105（40.7）
传统组Control group	201	8（4.0）	76（37.8）	25（12.4）	25（12.4）	1（0.7）	106（52.7）
χ²值		0.518	1.373	0.675	0.225	<0.0001	6.592
P值		>0.05	>0.05	>0.05	>0.05	>0.05	<0.05

分组Groups	例数Number of cases	急性肾功能异常Acute kidney injury	慢性肾功能异常加重Progression of chronic kidney disease	肢体血栓Venous thromboembolism	心血管事件Cardiovascular events	切口愈合不良Delayed wound healing	并发症Ccomplications
新模式组Experimental group	258	14（5.4）	84（32.6）	39（15.1）	36（14.0）	2（0.8）	105（40.7）
传统组Control group	201	8（4.0）	76（37.8）	25（12.4）	25（12.4）	1（0.7）	106（52.7）
χ²值		0.518	1.373	0.675	0.225	<0.0001	6.592
P值		>0.05	>0.05	>0.05	>0.05	>0.05	<0.05

项目Subjects	新模式组Experimental group	传统组Control group	t值	P值
病史采集History taking	8.8±1.5	7.4±2.1	-5.754	<0.001
体格检查Physical examination	8.3±1.5	7.0±2.1	-5.293	<0.001
医疗文件书写Clinical documentation	8.5±1.5	7.4±2.1	-4.478	<0.001
诊断能力Diagnostic proficiency	8.5±1.5	7.3±2.0	-5.000	<0.001
鉴别诊断Differential diagnosis	8.4±1.5	6.8±1.8	-7.071	<0.001
治疗方案选择Therapeutic decision-making	8.4±1.5	7.3±2.0	-4.682	<0.001
专科操作技术Specialty-specific technical skills	8.6±1.5	7.4±2.1	-4.607	<0.001
急诊处理Emergency management	8.7±1.5	7.7±1.9	-4.440	<0.001
实验室检查与辅助检查应用Diagnostic test utilization & interpretation	8.6±1.5	7.3±1.9	-5.545	<0.001
专业理论知识Professional theoretical Knowledge	8.4±1.5	7.2±1.9	-5.362	<0.001
总分Total score	85.3±5.0	72.7±5.6	-17.147	<0.001

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