From me needs knee to knee needs me:transition of perioperative care for people that chose to have total knee replacement surgery by augmenting activity and personalized functional goalsetting

People with severe arthrosis may choose to receive total knee replacement after having experienced pain and movement limitations for years. This is a major surgical procedure aimed at improving the patient’s quality of life by reduction of symptoms. However, disappointing results after hospital admission and surgery are shown in some, particularly elderly and vulnerable, patients. This dissertation describes the development, implementation and effectiveness of changes in care pathway for people receiving total knee replacement. This new care pathway not only focusses on surgical repair of the patient’s knee, but also on physical activities of the person behind the patient, both before and after surgery. The interdisciplinary team at the nursing ward of the hospital selected for this study changed the usual hospital approach and infrastructure. The team also made major adjustments to the perioperative process. The aim was to allow patients to be constantly physically active both before and after surgery in order to prevent any negative effects of hospitalisation. The development and use of predictive models to preoperatively identify patients at an increased risk of negative effects of total knee replacement played a key role in this. Changes in the process included implementing fast-track surgery and providing targeted rehabilitation programmes throughout the day at the nursing ward instead of offering half-hour sessions at the exercise room at the Physiotherapy Department. Vulnerable (i.e. high-risk) patients have recently started training at home as well prior to surgery. As a result, patients admitted to the hospital in Drachten are optimally physically prepared, based on the principle: better in, better out!This gradual change in care pathway took 6 years to materialise and resulted in patients being active at the nursing ward within 4 hours of surgery and being discharged from hospital two days earlier on average