Application of full-cycle rehabilitation management model based on multi-disciplinary collaboration in day surgery for hip and knee arthroplasty_West China Medical Journal

Authors：

ZHOU Wei ¹ , LIANG Li ² , FANG Kaiyun ³ , XU Hua ⁴ , CAO Runmin ⁴ , DUAN Hongmin ¹ , LI Senlei ¹ , LI Bo ¹ , YANG Xianteng ¹ , DING Qiuyue ¹ , PAN Runsang ¹ ,  SUN Li ¹

1. Department of Orthopedics, Guizhou Provincial People’s Hospital, Guiyang, Guizhou 550002, P. R. China;
2. Department of Medical Affairs, Guizhou Provincial People’s Hospital, Guiyang, Guizhou 550002, P. R. China;
3. Department of Anesthesiology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou 550002, P. R. China;
4. Department of Computer Science, Tsinghua University, Beijing 100084, P. R. China;

Corresponding?author：

SUN Li, Email: 1060561853@qq.com

Keywords：

Multi-disciplinary collaboration; full-cycle rehabilitation management; total hip arthroplasty; total knee arthroplasty; day surgery

DOI：

10.7507/1002-0179.202603175

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Objective To investigate the impacts of an attending physician-led full-cycle rehabilitation management model based on multi-disciplinary collaboration (integrating anesthesia, rehabilitation and nursing resources) on functional recovery and medical safety in patients undergoing primary unilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA) day surgery. Methods Patients scheduled for primary unilateral THA or TKA at the Department of Orthopedics, Guizhou Provincial People’s Hospital, between April 2024 and March 2025 were included. Participants were randomly allocated to an intervention group or control group using block randomization in a 1:1 ratio. The improvement in Western Ontario and McMaster Universities Osteoarthritis Index total score at 6 weeks postoperatively, successful discharge within 48 hours, rate of unplanned readmission at 30 days and 90 days, Harris Hip Score / Hospital for Special Surgery Knee Score scores, and patient satisfaction, were analyzed in both groups six weeks after surgery. Results A total of 200 patients were enrolled, with 100 cases in each group. Compared with the control group, the intervention group showed greater improvements in Western Ontario and McMaster Universities Osteoarthritis Index scores (32.7±6.4 vs. 26.1±7.2), 48-hour discharge success rate (92.0% vs. 79.0%), 30-day unplanned readmission rate (4.0% vs. 11.0%), 90-day unplanned readmission rate (6.0% vs. 14.0%), 6-week hip function (in the THA subgroup) (42.1±10.3 vs. 34.8±11.5), Knee Society score (in the TKA subgroup) (39.4±9.1 vs. 31.2±10.0), and patient satisfaction (70.2±4.3 vs. 63.5±5.6) (P<0.05). The effective response rate to post-discharge alerts within 48 hours was 95.2%, and the training completion rate was (87.5±9.2)%. No serious complications such as deep vein thrombosis or pulmonary embolism occurred in either group. Conclusion A multidisciplinary, full-cycle rehabilitation model led by the attending physician enables continuous care from pre-hospitalization through post-discharge, promoting better functional recovery and higher discharge efficiency than conventional enhanced recovery after surgery protocols, without increasing safety risks.

Citation： ZHOU Wei, LIANG Li, FANG Kaiyun, XU Hua, CAO Runmin, DUAN Hongmin, LI Senlei, LI Bo, YANG Xianteng, DING Qiuyue, PAN Runsang, SUN Li. Application of full-cycle rehabilitation management model based on multi-disciplinary collaboration in day surgery for hip and knee arthroplasty. West China Medical Journal, 2026, 41(8): 1300-1305. doi: 10.7507/1002-0179.202603175 Copy

1.	國家衛生健康委員會發布《醫療機構門診質量管理暫行規定》[J]. 中國數字醫學, 2022, 17(6): 14.
2.	Wainwright TW, Memtsoudis SG, Kehlet H. Fast-track hip and knee arthroplasty..how fast?[J]. Br J Anaesth, 2021, 126(2): 348-349.
3.	江志偉, 李寧, 黎介壽. 快速康復外科的概念及臨床意義[J]. 中國實用外科雜志, 2007(2): 131-133.
4.	Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: enhanced recovery after surgery (ERAS^?) society recommendations[J]. Acta Orthop, 2020, 91(1): 3-19.
5.	謝艷, 陳佳麗, 寧寧, 等. 加速康復下髖/膝關節置換術患者術前預康復最佳證據總結[J]. 華西醫學, 2022, 37(10): 1517-1523.
6.	周宗科, 翁習生, 曲鐵兵, 等. 中國髖、膝關節置換術加速康復——圍術期管理策略專家共識[J]. 中華骨與關節外科雜志, 2016, 9(1): 1-9.
7.	易知非, 羅雪峰, 何佳奇, 等. 基于 BNP 和 IL-6 的列線圖模型在預測老年髖部骨折患者術后主要不良心血管事件發生風險的價值[J]. 疑難病雜志, 2024, 23(4): 451-456.
8.	吳松梅, 張艷, 陳睿, 等. 國外髖膝關節置換術后當日出院的護理管理和啟示[J]. 中華現代護理雜志, 2022, 28(8): 981-985.
9.	Zhu H, You M, Wei J, et al. Orem’s self-care model of nursing care: a retrospective study with elders after hip arthroplasty[J]. Nurs Sci Q, 2024, 37(2): 148-153.
10.	Bolam SM, Batinica B, Yeung TC, et al. Remote patient monitoring with wearable sensors following knee arthroplasty[J]. Sensors (Basel), 2021, 21(15): 5143.
11.	Ouendi N, Avril E, Dervaux B, et al. Effectiveness of telerehabilitation programs in elderly with hip or knee arthroplasty: a systematic review[J]. Telemed J E Health, 2024, 30(6): 1507-1521.
12.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg Am, 1969, 51(4): 737-755.
13.	Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system[J]. Clin Orthop Relat Res, 1989(248): 13-14.
14.	陳彩芳, 黃曉萱, 劉廣美, 等. 日間手術患者就醫體驗調查及影響因素分析[J]. 中國普通外科雜志, 2026, 35(1): 192-197.
15.	Gandhi M, Ang FJL, Neo SHS, et al. Quality of care for patients with advanced illness scale: development, preference elicitation, and evaluation of measurement properties[J]. Value Health, 2025, 28(9): 1417-1425.
16.	McIsaac DI, Jen T, Mookerji N, et al. Interventions to improve the outcomes of frail people having surgery: a systematic review[J]. PLoS One, 2017, 12(12): e0190071.
17.	Adebero T, Omana H, Somerville L, et al. Effectiveness of prehabilitation on outcomes following total knee and hip arthroplasty for osteoarthritis: a systematic review and meta-analysis of randomized controlled trials[J]. Disabil Rehabil, 2024, 46(24): 5771-5790.
18.	景丹丹, 李寧, 劉彥, 等. 眼科日間手術患者就醫體驗及分階段照護需求的質性研究[J]. 中華現代護理雜志, 2023, 29(6): 810-814.
19.	Gromov K, Kj?rsgaard-Andersen P, Revald P, et al. Feasibility of outpatient total hip and knee arthroplasty in unselected patients[J]. Acta Orthop, 2017, 88(5): 516-521.
20.	Ardon AE. Safety considerations for outpatient arthroplasty[J]. Clin Sports Med, 2022, 41(2): 281-289.
21.	French JMR, Woods A, Sayers A, et al. Day-case knee and hip replacement[J]. Bone Joint J, 2024, 106-B(12): 1385-1392.
22.	譚蓉, 張景碩. “互聯網+全程管理”模式在關節置換日間手術患者中的應用[J]. 中國衛生標準管理, 2025, 16(19): 84-89.
23.	Nuevo M, Rodríguez-Rodríguez D, Jauregui R, et al. Telerehabilitation following fast-track total knee arthroplasty is effective and safe: a randomized controlled trial with the ReHub^? platform[J]. Disabil Rehabil, 2024, 46(12): 2629-2639.
24.	Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: clinical nutrition in surgery[J]. Clin Nutr, 2021, 40(7): 4745-4761.
25.	Kampitak W, Tanavalee A, Ngarmukos S, et al. Opioid-sparing analgesia and enhanced recovery after total knee arthroplasty using combined triple nerve blocks with local infiltration analgesia[J]. J Arthroplasty, 2019, 34(2): 295-302.
26.	Feng P, Feng L, Xiong Z, et al. A comparison of efficacy and safety of oral versus intravenous applications of tranexamic acid in total hip and knee arthroplasty: an updated systematic review meta-analysis of randomized controlled trials[J]. BMC Musculoskelet Disord, 2025, 26(1): 914.

1. 國家衛生健康委員會發布《醫療機構門診質量管理暫行規定》[J]. 中國數字醫學, 2022, 17(6): 14.
2. Wainwright TW, Memtsoudis SG, Kehlet H. Fast-track hip and knee arthroplasty..how fast?[J]. Br J Anaesth, 2021, 126(2): 348-349.
3. 江志偉, 李寧, 黎介壽. 快速康復外科的概念及臨床意義[J]. 中國實用外科雜志, 2007(2): 131-133.
4. Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: enhanced recovery after surgery (ERAS^?) society recommendations[J]. Acta Orthop, 2020, 91(1): 3-19.
5. 謝艷, 陳佳麗, 寧寧, 等. 加速康復下髖/膝關節置換術患者術前預康復最佳證據總結[J]. 華西醫學, 2022, 37(10): 1517-1523.
6. 周宗科, 翁習生, 曲鐵兵, 等. 中國髖、膝關節置換術加速康復——圍術期管理策略專家共識[J]. 中華骨與關節外科雜志, 2016, 9(1): 1-9.
7. 易知非, 羅雪峰, 何佳奇, 等. 基于 BNP 和 IL-6 的列線圖模型在預測老年髖部骨折患者術后主要不良心血管事件發生風險的價值[J]. 疑難病雜志, 2024, 23(4): 451-456.
8. 吳松梅, 張艷, 陳睿, 等. 國外髖膝關節置換術后當日出院的護理管理和啟示[J]. 中華現代護理雜志, 2022, 28(8): 981-985.
9. Zhu H, You M, Wei J, et al. Orem’s self-care model of nursing care: a retrospective study with elders after hip arthroplasty[J]. Nurs Sci Q, 2024, 37(2): 148-153.
10. Bolam SM, Batinica B, Yeung TC, et al. Remote patient monitoring with wearable sensors following knee arthroplasty[J]. Sensors (Basel), 2021, 21(15): 5143.
11. Ouendi N, Avril E, Dervaux B, et al. Effectiveness of telerehabilitation programs in elderly with hip or knee arthroplasty: a systematic review[J]. Telemed J E Health, 2024, 30(6): 1507-1521.
12. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg Am, 1969, 51(4): 737-755.
13. Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system[J]. Clin Orthop Relat Res, 1989(248): 13-14.
14. 陳彩芳, 黃曉萱, 劉廣美, 等. 日間手術患者就醫體驗調查及影響因素分析[J]. 中國普通外科雜志, 2026, 35(1): 192-197.
15. Gandhi M, Ang FJL, Neo SHS, et al. Quality of care for patients with advanced illness scale: development, preference elicitation, and evaluation of measurement properties[J]. Value Health, 2025, 28(9): 1417-1425.
16. McIsaac DI, Jen T, Mookerji N, et al. Interventions to improve the outcomes of frail people having surgery: a systematic review[J]. PLoS One, 2017, 12(12): e0190071.
17. Adebero T, Omana H, Somerville L, et al. Effectiveness of prehabilitation on outcomes following total knee and hip arthroplasty for osteoarthritis: a systematic review and meta-analysis of randomized controlled trials[J]. Disabil Rehabil, 2024, 46(24): 5771-5790.
18. 景丹丹, 李寧, 劉彥, 等. 眼科日間手術患者就醫體驗及分階段照護需求的質性研究[J]. 中華現代護理雜志, 2023, 29(6): 810-814.
19. Gromov K, Kj?rsgaard-Andersen P, Revald P, et al. Feasibility of outpatient total hip and knee arthroplasty in unselected patients[J]. Acta Orthop, 2017, 88(5): 516-521.
20. Ardon AE. Safety considerations for outpatient arthroplasty[J]. Clin Sports Med, 2022, 41(2): 281-289.
21. French JMR, Woods A, Sayers A, et al. Day-case knee and hip replacement[J]. Bone Joint J, 2024, 106-B(12): 1385-1392.
22. 譚蓉, 張景碩. “互聯網+全程管理”模式在關節置換日間手術患者中的應用[J]. 中國衛生標準管理, 2025, 16(19): 84-89.
23. Nuevo M, Rodríguez-Rodríguez D, Jauregui R, et al. Telerehabilitation following fast-track total knee arthroplasty is effective and safe: a randomized controlled trial with the ReHub^? platform[J]. Disabil Rehabil, 2024, 46(12): 2629-2639.
24. Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: clinical nutrition in surgery[J]. Clin Nutr, 2021, 40(7): 4745-4761.
25. Kampitak W, Tanavalee A, Ngarmukos S, et al. Opioid-sparing analgesia and enhanced recovery after total knee arthroplasty using combined triple nerve blocks with local infiltration analgesia[J]. J Arthroplasty, 2019, 34(2): 295-302.
26. Feng P, Feng L, Xiong Z, et al. A comparison of efficacy and safety of oral versus intravenous applications of tranexamic acid in total hip and knee arthroplasty: an updated systematic review meta-analysis of randomized controlled trials[J]. BMC Musculoskelet Disord, 2025, 26(1): 914.

West China Medical Journal

Application of full-cycle rehabilitation management model based on multi-disciplinary collaboration in day surgery for hip and knee arthroplasty

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