MULTIDISCIPLINARY PERIOPERATIVE STRATEGIES TO IMPROVE OUTCOMES IN OSTEOARTHRITIS PATIENTS UNDERGOING JOINT REPLACEMENT: A SYSTEMATIC REVIEW
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Keywords
Osteoarthritis; Joint Replacement; Total Knee Arthroplasty; Total Hip Arthroplasty; Enhanced Recovery After Surgery; Multidisciplinary Care; Perioperative Strategies; prehabilitation; Infection Prevention; Functional Recovery
Abstract
Background: Osteoarthritis (OA) is a leading cause of disability, and joint replacement remains the gold-standard intervention for advanced disease. Perioperative challenges such as pain, infection, and delayed mobilization necessitate comprehensive care strategies. Multidisciplinary perioperative interventions, including enhanced recovery after surgery (ERAS) protocols, prehabilitation, and preoperative optimization, have gained increasing attention.
Objective: To synthesize evidence on the impact of multidisciplinary perioperative strategies on outcomes in OA patients undergoing hip or knee joint replacement.
Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Embase, MEDLINE, Scopus, and Cochrane Library were searched through March 2024. Eligible studies included adults undergoing arthroplasty for OA with perioperative multidisciplinary interventions. Outcomes assessed included pain, complications, length of stay (LOS), functional recovery, and patient satisfaction. Risk of bias was evaluated using Cochrane and Newcastle-Ottawa tools.
Results: Eleven studies were included, comprising randomized controlled trials, cohort studies, systematic reviews, and narrative reviews. ERAS-based strategies consistently reduced LOS, opioid use, and complications, while improving functional outcomes and satisfaction. Subgroup analyses indicated particular benefits for elderly and high-risk patients, with nursing-led ERAS interventions enhancing recovery in frail populations. Prehabilitation showed mixed results, with potential benefits in patients with metabolic syndrome. Infection prevention optimization reduced per prosthetic joint infections. Study heterogeneity and variable quality limited comparability.
Conclusion: Multidisciplinary perioperative strategies, especially ERAS protocols, improve clinical and patient-centered outcomes in OA patients undergoing joint replacement. Routine integration of such approaches is recommended, although further high-quality, standardized studies are needed to refine best practices.
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Dr. Shilaga Dhar
Assistant Professor, Anesthesia, Adesh Medical College and Hospital, Mohri, Shahbad, Haryana
Dr. Brahmpreet Singh Nagpal
Associate Professor, Orthopedics, Adesh Medical College and Hospital, Mohri, Shahbad, Haryana
Dr. Sanjeev Kapoor
3Consultant & Head, rthopedics, Joint Replacement Center, Army Hospital (Research & Referral), New Delhi
Dr. Sanjana Devi
Assistant Professor, Anatomy, GGSMCH, Faridkot, Punjab