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Abstract：
BACKGROUND: Early postoperative mobilization is essential for early functional recovery but can be inhibited by postoperative orthostatic intolerance (OI). Postoperative OI is common after major surgery, such as total knee arthroplasty (TKA). However, limited data are available after less extensive surgery, such as unicompartmental knee arthroplasty (UKA). We, therefore, investigated the incidence of OI as well as cardiovascular and tissue oxygenation responses during early mobilization after UKA.
METHODS: This prospective single-centre observational study included 32 patients undergoing primary UKA. Incidence of OI and cardiovascular and tissue oxygenation responses during mobilization were evaluated preoperatively, at 6 and 24 h after surgery. Perioperative fluid balance, bleeding, surgery duration, postoperative hemoglobin, pain during mobilization and opioid usage were recorded.
RESULTS: During mobilization at 6 h after surgery, 4 (14%, 95%CI 4-33%) patients experienced OI; however, no patients terminated the mobilization procedure prematurely. Dizziness and feeling of heat were the most common symptoms. OI was associated with attenuated systolic and mean arterial blood pressure responses in the sitting position (all p < 0.05). At 24 h after surgery, 24 (75%) patients had already been discharged, including three of the four patients with early OI. Only five patients were available for measurements, two of whom experienced OI; one terminated the mobilization procedure due to intolerable symptoms. We observed no statistically significant differences in perioperative fluid balance, bleeding, surgery duration, postoperative hemoglobin, pain, or opioid usage between orthostatic intolerant and tolerant patients.
CONCLUSIONS: The incidence of orthostatic intolerance after fast-track unicompartmental knee arthroplasty is low (~ 15%) and is associated with decreased orthostatic pressure responses. Compared to the previously described orthostatic intolerance incidence of ~ 40% following total knee arthroplasty, early orthostatic intolerance is uncommon after unicompartmental knee arthroplasty, suggesting a procedure-specific component.
BACKGROUND: Prospectively registered at ClinicalTrials.gov; registration number: NCT04195360, registration date: 13.12.2019.
METHODS: This prospective single-centre observational study included 32 patients undergoing primary UKA. Incidence of OI and cardiovascular and tissue oxygenation responses during mobilization were evaluated preoperatively, at 6 and 24 h after surgery. Perioperative fluid balance, bleeding, surgery duration, postoperative hemoglobin, pain during mobilization and opioid usage were recorded.
RESULTS: During mobilization at 6 h after surgery, 4 (14%, 95%CI 4-33%) patients experienced OI; however, no patients terminated the mobilization procedure prematurely. Dizziness and feeling of heat were the most common symptoms. OI was associated with attenuated systolic and mean arterial blood pressure responses in the sitting position (all p < 0.05). At 24 h after surgery, 24 (75%) patients had already been discharged, including three of the four patients with early OI. Only five patients were available for measurements, two of whom experienced OI; one terminated the mobilization procedure due to intolerable symptoms. We observed no statistically significant differences in perioperative fluid balance, bleeding, surgery duration, postoperative hemoglobin, pain, or opioid usage between orthostatic intolerant and tolerant patients.
CONCLUSIONS: The incidence of orthostatic intolerance after fast-track unicompartmental knee arthroplasty is low (~ 15%) and is associated with decreased orthostatic pressure responses. Compared to the previously described orthostatic intolerance incidence of ~ 40% following total knee arthroplasty, early orthostatic intolerance is uncommon after unicompartmental knee arthroplasty, suggesting a procedure-specific component.
BACKGROUND: Prospectively registered at ClinicalTrials.gov; registration number: NCT04195360, registration date: 13.12.2019.
摘要：
背景：术后早期活动对于早期功能恢复至关重要，但术后直立不耐受（OI）可以抑制。术后OI在大手术后很常见，如全膝关节置换术（TKA）。然而,在不太广泛的手术后可获得的数据有限，如单室膝关节置换术（UKA）。我们,因此,调查了UKA术后早期动员期间OI的发生率以及心血管和组织氧合反应。
方法：这项前瞻性单中心观察性研究包括32例接受原发性UKA的患者。术前评估动员期间OI和心血管和组织氧合反应的发生率，在手术后6和24小时。围手术期液体平衡；出血,手术持续时间,术后血红蛋白,记录动员过程中的疼痛和阿片类药物的使用情况.
结果：在手术后6小时动员期间，4（14%，95CI4-33%)患者经历了OI；然而，没有患者过早终止动员程序。头晕和感觉热是最常见的症状。OI与坐位的收缩压和平均动脉血压反应减弱相关（均p<0.05）。手术后24小时，24名（75％）患者已经出院，包括四名早期OI患者中的三名。只有五名患者可以进行测量，其中两人经历了OI;一个由于难以忍受的症状而终止了动员程序。我们观察到围手术期液体平衡无统计学差异，出血,手术持续时间,术后血红蛋白,疼痛,或阿片类药物在直立不耐受和耐受患者之间的使用。
结论：快速单室膝关节置换术后体位不耐受的发生率较低（约15%），且与体位压力反应降低相关。与先前描述的全膝关节置换术后约40％的直立不耐受发生率相比，单室膝关节置换术后早期体位不耐受并不常见，建议特定于程序的组件。
背景：在ClinicalTrials.gov进行了前瞻性注册；注册编号：NCT04195360，注册日期：13.12.2019。
方法：这项前瞻性单中心观察性研究包括32例接受原发性UKA的患者。术前评估动员期间OI和心血管和组织氧合反应的发生率，在手术后6和24小时。围手术期液体平衡；出血,手术持续时间,术后血红蛋白,记录动员过程中的疼痛和阿片类药物的使用情况.
结果：在手术后6小时动员期间，4（14%，95CI4-33%)患者经历了OI；然而，没有患者过早终止动员程序。头晕和感觉热是最常见的症状。OI与坐位的收缩压和平均动脉血压反应减弱相关（均p<0.05）。手术后24小时，24名（75％）患者已经出院，包括四名早期OI患者中的三名。只有五名患者可以进行测量，其中两人经历了OI;一个由于难以忍受的症状而终止了动员程序。我们观察到围手术期液体平衡无统计学差异，出血,手术持续时间,术后血红蛋白,疼痛,或阿片类药物在直立不耐受和耐受患者之间的使用。
结论：快速单室膝关节置换术后体位不耐受的发生率较低（约15%），且与体位压力反应降低相关。与先前描述的全膝关节置换术后约40％的直立不耐受发生率相比，单室膝关节置换术后早期体位不耐受并不常见，建议特定于程序的组件。
背景：在ClinicalTrials.gov进行了前瞻性注册；注册编号：NCT04195360，注册日期：13.12.2019。
