Maxime Sadoun1, Alexandre Hardy2, Victoire Cladière3, Leah Guichard4, Thomas Bauer1, Yves Stiglitz5,6. 1. Department of Orthopedics, Ambroise Paré University Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, Paris, France. 2. Clinique du Sport, Paris 5, 36 boulevard Saint-Marcel, 75005, Paris, France. 3. Department of Orthopedics, Cochin University Hospital, APHP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France. 4. Department of Anesthesiology, Raymond Poincaré Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, 104 Boulevard Raymond Poincaré, 92380, Garches, Paris, France. 5. Clinique Victor Hugo, 5 rue du Dôme, 75116, Paris, France. yves.stiglitz@free.fr. 6. Department of Orthopaedics, Raymond Poincaré Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, 104 Boulevard Raymond Poincaré, 92380, Garches, Paris, France. yves.stiglitz@free.fr.
Abstract
INTRODUCTION: Since the development of the last generation of implants total ankle replacements (TAR) is becoming more and more popular in patients and in specialized surgeon teams, the trend for outpatient surgery is growing, and protocols now are well established for hip or knee replacement. We adapted a protocol for outpatient TAR and hypothesized that it could be performed safely as standard procedure. PATIENTS AND METHODS: Twenty-five consecutive patients among 141 TAR were treated with our outpatient protocol relying on three fundamentals: bleed control, pain control, and autonomy. They received 1 g of tranexamic acid before surgery, and after discard from post-operative care unit, they were operated under long-lasting nerve block precociously relayed by oral NSAIDs and had an immediate full weight-bearing authorization at discharge. RESULTS: No patients we readmitted for an acute care following TAR, especially for haematoma or uncontrolled pain. Mean VAS was < 1 before discharge from post-operative care unit and < 2 until day 90. One patient had a delayed wound healing treated surgically at day 30 without implant revision. CONCLUSION: Outpatient TAR is possible and safe if a risk management process is used, and the three basic principles for outpatient procedures are respected: bleed control, pain control, and patient autonomy. We consider now this modality as a routine.
INTRODUCTION: Since the development of the last generation of implants total ankle replacements (TAR) is becoming more and more popular in patients and in specialized surgeon teams, the trend for outpatient surgery is growing, and protocols now are well established for hip or knee replacement. We adapted a protocol for outpatient TAR and hypothesized that it could be performed safely as standard procedure. PATIENTS AND METHODS: Twenty-five consecutive patients among 141 TAR were treated with our outpatient protocol relying on three fundamentals: bleed control, pain control, and autonomy. They received 1 g of tranexamic acid before surgery, and after discard from post-operative care unit, they were operated under long-lasting nerve block precociously relayed by oral NSAIDs and had an immediate full weight-bearing authorization at discharge. RESULTS: No patients we readmitted for an acute care following TAR, especially for haematoma or uncontrolled pain. Mean VAS was < 1 before discharge from post-operative care unit and < 2 until day 90. One patient had a delayed wound healing treated surgically at day 30 without implant revision. CONCLUSION: Outpatient TAR is possible and safe if a risk management process is used, and the three basic principles for outpatient procedures are respected: bleed control, pain control, and patient autonomy. We consider now this modality as a routine.
Authors: Cort D Lawton; Bennet A Butler; Robert G Dekker; Adam Prescott; Anish R Kadakia Journal: J Orthop Surg Res Date: 2017-05-18 Impact factor: 2.359