Skip to main content
  • Research article
  • Open access
  • Published:

Fast-track surgery and telerehabilitation protocol in unicompartmental knee arthroplasty leads to superior outcomes when compared with the standard protocol: a propensity-matched pilot study



Several strategies have been devised to reduce the length of stay after orthopedic surgery. Telerehabilitation has proved effective in functional outcomes after orthopedic procedures and is appreciated by patients. There is limited information on fast-track surgery and telerehabilitation protocols for unicompartmental knee arthroplasty (UKA). The purpose of this pilot study was to report and compare functional outcomes and satisfaction levels during first 12 months of recovery in patients who underwent UKA according to a fast-track and telerehabilitation protocol (G1) or standard surgery and rehabilitation program (G2).


Data were retrospectively collected and reviewed for all elective UKAs from January 2018 to November 2019. A total of seven patients undergoing UKA according to the fast-track and telerehabilitation protocol were propensity score matched (1:3 ratio) to 21 patients undergoing standard surgery and rehabilitation. Patients were matched for age, sex, body mass index (BMI), and laterality. The Western Ontario and McMaster University (WOMAC) osteoarthritis index and range of motion (ROM) were collected pre- and postoperatively in both groups for 12 months. In addition, patient’ satisfaction was collected at 40 days.


The G1 group demonstrated significantly better outcomes in WOMAC index scores at 2, 15, and 40 days (p < 0.001, p < 0.001, p < 0.020, respectively) and a significantly greater knee ROM after surgery and at 2, 15, 40, and 12 months (p < 0.001, p < 0.001, p = 0.014, p < 0.001, p = 0.003, respectively). No patients in either group had postoperative complications. One patient was not completely satisfied in the G2, while no one in G1 reported not being completely satisfied (p = 1.000).


This fast-track and telerehabilitation protocol after UKA can potentially be applied to patients as it is safe and effective. At 12-months follow-up, both groups reported favorable outcomes after UKA. However, the G1 score was better regarding WOMAC and ROM when compared with the propensity score-matched G2 program. A larger study is warranted to explore the role of fast-track and telerehabilitation in clinical and functional outcomes of UKA.


In the last 20 years, isolated unicompartmental osteoarthritis has increasingly been treated by unicompartmental knee arthroplasty (UKA), which has a faster short-term recovery and reduced postoperative pain and morbidity than total knee arthroplasty [1, 2]. In the past decade, fast-track protocols have been introduced in clinical and care pathways for elective joint replacement [3, 4]. They are characterized by changes to the surgical procedure and the post-discharge function [5, 6] and by the participation of different specialists at all stages [3, 7]. Their goal is to reduce the physiological and psychological stress of surgery, achieve earlier mobilization and faster recovery, and reduce length of stay (LOS) and hospital costs [8].

Notably, changes in perioperative analgesia, nursing care, and rehabilitation have markedly reduced LOS for these procedures; in particular, effective pain management is critical for faster recovery and earlier discharge after lower limb arthroplasty [9, 10]. Other key factors for successful recovery are preoperative rehabilitation and muscle strengthening as well as early postoperative rehabilitation [11, 12]. Interestingly, shorter hospital stays are associated with better total joint replacement outcomes and greater patient satisfaction [13, 14]. Yet, UKA is still considered a major procedure requiring prolonged hospitalization, mainly due to surgeons’ concerns over postoperative complications, such as an increase in the rates of readmission or return to theater, postoperative blood transfusion requirements, cardiac ischemic events, and 30- and 90-day mortality, as well as patients’ concerns over pain control and rehabilitation at home [15].

In recent years, telerehabilitation has increasingly been used as a supplement or even an alternative to conventional face-to-face physical therapy [16]. In telerehabilitation, sensors and software enable therapists to assess progress remotely, and patients feel closely monitored and supported [17]. Results are comparable to those obtained with outpatient physical therapy and even with face-to-face home rehabilitation [18]. Moreover, telerehabilitation is well accepted by patients [19, 20].

To the best of our knowledge, this is the first study that use a propensity score-matched analysis to compare clinical outcomes and satisfaction rate in patients who underwent UKA following a fast-track and telerehabilitation protocol (G1) or a standard surgery and rehabilitation protocol (G2).

The purpose of this pilot study was to report and compare functional outcomes [i.e., Western Ontario and McMaster University (WOMAC) and range of motion (ROM)], complications, and satisfaction levels during the first 12 months of recovery in patients who underwent UKA according to protocol G1 or program G2. We hypothesized that patients who underwent a fast-track and telerehabilitation protocol could achieve earlier better functional outcomes and satisfaction levels without a higher complication rate.


Study design:

This was a pilot retrospective clinical trial.

Patient selection criteria

The data were retrospectively collected and reviewed for all patients who underwent primary UKA by the senior author (M.S.). Patients were included if they underwent a UKA in a fast-track surgery and telerehabilitation protocol (Group 1) or in a standard protocol (Group 2). Patients in Group 1 were enrolled according to fast-track and telerehabilitation protocol inclusion criteria. From January 2018 to November 2019, a total of 99 patients underwent UKA. Of these,18 followed the fast-track and telerehabilitation protocol, while 81 followed the standard protocol, 3 of which failed to complete the 12-month follow-up. After propensity score matching (PSM), 7 patients of Group 1 were successfully matched with 21 patients of Group 2 (Fig. 1). There were no statistically significant differences in body mass index (BMI), smoking status, alcohol use, and allergies between G1 and G2 (Table 1).

Fig. 1
figure 1

Flow of patients during the study period. UKA unicompartmental knee arthroplasty

Table 1 Preoperative and perioperative characteristics of the UKA patients

The minimum follow-up time was 12 months and included Western Ontario and McMaster University (WOMAC) osteoarthritis index, range of motion (ROM), and patient satisfaction. Any revision surgeries or complications were also documented. This study was approved by our institutional review board.

Indications for surgery

All patients received a diagnosis of unicompartmental osteoarthritis/osteonecrosis of the knee based on their medical history, physical examination, and radiographic evaluation [21]. Inclusion criteria to undergoing UKA were as follows: unicompartmental osteoarthritis/osteonecrosis of the knee, correctable varus/valgus deformity; flexion contracture ≤ 5°; intact cruciate ligaments. A cemented medial or lateral GKS ONE prosthesis (Permedica, Merate, Italy) was implanted by the senior surgeon (M.S.) in all patients. The procedure was performed without a tourniquet, using an 8–10 cm minimally invasive lateral or medial parapatellar approach.

Indication of fast-track UKA and telerehabilitation protocol

Inclusion criteria for the fast-track UKA and telerehabilitation protocol were: body mass index (BMI) < 30 kg/m2, American Society of Anesthesiologists (ASA) class 1–2 [22], physical and psychological motivation, a supportive home environment, motivated and available caregiver(s), ability to use crutches, aptitude to manage the telerehabilitation digital program, a home internet connection, willingness to engage in early home rehabilitation followed by outpatient rehabilitation, and residence within 30 km of the hospital. Exclusion criteria were allergy/hypersensitivity to any of the drugs used in the fast-track protocol (cefazolin, hyperbaric bupivacaine, tranexamic acid, paracetamol, levobupivacaine, oxycodone, naloxone, ketorolac, tramadol, alizapride, parnaparin), congenital/acquired coagulopathy, active intravascular coagulation, acute occlusive vasculopathy, chronic cardiopathy, chronic use of oral anticoagulants/corticosteroids, malignancy, autoimmune disease, major bone defects requiring bone grafting, and refusal to sign the informed consent form.

Fast-track and telerehabilitation protocol

  1. (a)

    Preoperative phase

    Pre-admission included medical, pre-anesthetic, and physiotherapy evaluation and assessment of family members, to assign roles to those who will be involved in patient care at home.

    Since a bladder catheter is not used, intraoperative water overload was avoided. Fats and meat were allowed up to 8 h before surgery, a light meal was allowed up to 6 h, and only fluids were allowed up to 2 h before surgery. Clear liquids (water, tea, chamomile tea) were permitted 2 h after surgery.

  2. (b)

    Operative phase

    Patients received a 2 ml subarachnoid injection of 0.5% hyperbaric bupivacaine and breathed spontaneously with 2 l/min of supplementary oxygen. Normothermia > 36 °C was maintained with hot air. A minimally invasive procedure was used. Twenty minutes before the incision, patients received 1 g intravenous tranexamic acid [15, 23, 24]. Operative times were kept as short as possible (< 60 min) to reduce surgical stress [23, 25,26,27]. Before wound closure, local infiltration of anesthetic (LIA; 20 ml 0.25% levobupivacaine) [26, 28] was performed by the surgeon using a systematic technique. To ensure uniform anesthetic delivery to all tissues that had been incised, handled, or instrumented, 10 ml was injected into the anterior joint capsule and 10 ml into subcutaneous tissue [28, 29]. A standardized analgesia protocol with 1 g intravenous paracetamol three times a day was started 30 min before the end of the procedure.

  3. (c)

    Postoperative phase

    Immediate full weight-bearing was initiated. X-rays were taken and examined within 3 h of the patient leaving the operating room, to enable early rehabilitation.

    Pain medication followed a standardized protocol based on the numerical rating scale (NRS). Four hours after surgery, patients received oral oxycodone/naloxone (5/2.5 mg tablets) every hour; over the next 72 h they received a 10/5 mg tablet twice a day, to ensure an NRS ≤ 4 [30]. Pain NRS > 4 was managed by ketorolac 30 mg/tramadol 100 mg, one vial in 100 ml saline, twice a day for 48 h.

  4. (d)

    Hospital rehabilitation

    Four hours after the procedure, patients were examined and their rehabilitation chart was prepared by the physiotherapist. Active and passive limb mobilization was begun with the patient wearing elastic stockings on both lower extremities. Afterward, the patient was helped to take a short walk with the aid of a walker or crutches.

    Postoperative day (POD) 1 involved two physiotherapy sessions, again consisting of active and passive mobilization and of walking with crutches or a walker. On POD 2, the two sessions also involved negotiating stairs.

    Patients were usually discharged on POD 3. The discharge was agreed among the orthopedist, physiotherapist, internal medicine specialist, and patient, based on clinical condition and achievement of the short-term rehabilitation objectives. Patients were discharged home, where they received integrated home care according to the local health service protocols. The discharge letter, written by the orthopedist and the attending physician, specified the treatment program and the follow-up schedule.

  5. (e)

    Home rehabilitation

    The home rehabilitation goals were set by the physiotherapist. The daily program involved a 90-min morning session with the physical therapist and telerehabilitation (at least 30 min) in the afternoon.

    At the time of the first home session, the patient received a telerehabilitation kit, KARI (Euleria, Rovereto, Italy), containing the devices, which, through an internet connection, enable remote support and training supervision, including a magnetic bluetooth inertial sensor; magnetic charging cable; adjustable elastic velcro bands for the trunk, thigh, tibia, and foot; a carrying bag; and a tablet with the app already installed (Fig. 2).

Fig 2.
figure 2

a KARI system home kit; b KARI system, sensor positioning

After 8–10 days, patients began an outpatient rehabilitation regimen (three times a week, 1 h a day).

Standard pathway

The patients undergoing standard UKA and rehabilitation received routine surgical treatment and care. Rehabilitation began on POD 2 and involved a 90-min daily session with the physiotherapist in the morning and a 90-min session without the physiotherapist in the afternoon. After discharge, typically on POD 10–16, they began an outpatient rehabilitation program (1 h, three times a week) the duration of which was decided by the physiotherapist (usually 30–40 days). Compared with G1, in the standard protocol, patients LIA or analgesia protocol intraoperative were not use. No early mobilization and rehabilitation were begun immediately after surgical procedure. Painkillers were administered on demand.

Clinical outcomes

Preoperative and postoperative functional outcomes were obtained retrospectively. The collected measures were as follows: WOMAC osteoarthritis index preoperative, on POD 2, 15, and 40, and at 12 months; ROM immediately after surgery, on POD 2, 15, and 40, and at 12 months. In addition, patient satisfaction was collected on the day 40 (3: very satisfied; 2: satisfied; 1: not completely satisfied; and 0: dissatisfied). Outcome results were obtained through clinical appointment.

Statistical analysis

All analysis were conducted using Microsoft Excel (Microsoft) with the XLSTAT resource pack (XLSTAT-Premium, NY, USA). To adjust for differences in baseline characteristics, a propensity score matching (PSM) analysis was performed with 1:3 ratio (G1:G2).

To perform the matching operation, an optimal algorithm was used. In this way, it was possible to match each participant of the treatment group to three participants of the control group. Patients were eligible for matching if the difference of the estimated propensity score between G1 and G2 was within the caliper radius of 0.01* sigma. The strength of the association was estimated with the 95% confidence interval. Patients were matched for age, sex, body mass index (BMI), and laterality. Nonparametric (Mann–Whitney U) tests were used to assess continuous variables for significant differences between the two groups. Regarding categorical data, all measurements were compared using Fisher’s exact test. A p-value < 0.05 was defined as significant.


Clinical outcomes

G1 demonstrated significantly better clinical outcomes in WOMAC scores on POD 2, 15, and 40 (p < 0.001, p < 0.001, p < 0.020, respectively) and ROM immediately after surgery, on POD 2, 15, and 40, and at 12 months (p < 0.001, p < 0.001, p = 0.014, p < 0.001, p = 0.003, respectively) (Table 2).

Table 2 Matched patient outcomes scores:

Regarding patient satisfaction, no significant differences were found (p = 1.000).

Complications and revisions

No complications occurred in either Group 1 or Group 2. In addition, none of the included patients required a revision surgery.


In this pilot clinical trial, the most important finding was that G1 patients experienced higher functional outcomes than G2 patients, with a better WOMAC score at POD 2, 15, and 40. Moreover, G1 patients achieved more satisfactory results in ROM at POD 2, 15, and 40, and 1-year follow-up compared with G2. After PSM, there was a marked improvement in WOMAC from POD 2 to 40 in patients in the G1 group. This difference, however, tended to disappear in the following days and months. Moreover, we noted a statistically significant difference in ROM from the immediate postoperative period up to month 12 (Table 2). Patients who underwent a UKA with a fast-track and telerehabilitation protocol could achieve better range of motion.

With regards to patient satisfaction, after PSM, there was no statistically significant difference between the G1 and G2 patients. We also noted that in G2, there was only one patient who reported that he was not completely satisfied with the intra/postoperative management (Table 2).

The LOS after knee and hip arthroplasty has been declining for some years, especially with fast-track protocols [15]. A large body of literature has highlighted some major advantages of such protocols, including fewer cardiopulmonary complications, shorter heparin prophylaxis, healthcare savings, and a lower risk of postoperative delirium, especially in older patients [31, 32]. Telemedicine affords quantitatively greater and more consistent patient monitoring, it is associated with greater compliance, thus earlier recovery, and ensures greater patient satisfaction while affording substantial hospital savings [33,34,35]. Several studies have found that in various medical branches, virtual rehabilitation is equivalent to conventional rehabilitation [36], for instance, some investigations of knee arthroplasty have found comparable results in terms of ROM, strength, stability, pain, and quality of life [19, 37]. The success of telerehabilitation depends on several factors, including patient physical and emotional aptitude, a suitable home environment, and especially, the ability to use electronic devices [38]. Indeed, poor familiarity with electronic tools often excludes older patients from these programs. Telerehabilitation may encourage more patients to choose a fast-track protocol. Critically, at a time when COVID-19 is still a cause for deep concern, fast-track procedures and telerehabilitation provide unique social distancing opportunities. Greater patient compliance is another key benefit of these programs.

Effective pain relief is crucial for early mobilization and rehabilitation; moreover, pain delays discharge [39, 40]. Pain management involves both anesthesia and analgesia. While all patients received subarachnoid spinal anesthesia, LIA could have helped the early mobilization in Group 1 [29]. Whereas patients managed by conventional rehabilitation tend to avoid movement, those in a fast-track regimen immediately begin passive and active mobilization. Early mobilization is also the main factor that helps reduce complications such as thromboembolic episodes [41]. A large study comparing a fast-track hip and knee arthroplasty protocol to the standard approach has described a clear reduction in complications such as cardiac ischemic events, mortality, and red blood cell transfusions [15]. The significantly greater knee mobility achieved by Group 1 patients at each assessment suggests that early mobilization is the chief factor affecting postoperative ROM. This suggests a key role for the fast-track surgery and rehabilitation program.

This study has several limitations. First, the sample size is relatively small (n = 28) to detect the treatment effect of the fast-track and telerehabilitation protocol. Second, this is a nonrandomized study and includes a retrospective design. Third, although the propensity score analysis was used, comorbidities were not matched on, and this may have influenced our results. Fourth, the different protocol of pain management between groups, which would affect the early function (i.e., LIA).


In this pilot study of 28 subjects, the fast-track and telerehabilitation protocol in UKA proved to be safe and effective. At 12-months follow-up, both groups reported favorable outcomes after UKA. However, the G1 patients showed encouraging results regarding WOMAC and ROM compared with propensity score-matched patients in G2. No differences were found in grade of satisfaction and postoperative complications rate. Future studies with a larger population are warranted to explore the effects of fast-track and telerehabilitation protocols.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available, but they are available from the corresponding author on reasonable request.



Unicompartmental knee arthroplasty (UKA)


Group 1


Group 2


Western Ontario and McMaster University


Range of motion


Length of stay


Body mass index


American Society of Anesthesiologists


Propensity score match


Local infiltration of anesthetic


Numerical rating scale


Postoperative day


Standard deviation


  1. Brown NM, Sheth NP, Davis K, Berend ME, Lombardi AV, Berend KR et al. (2012) Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: a multicenter analysis. J Arthroplasty 27(8 SUPPL):86–90

    Article  Google Scholar 

  2. Piovan G, Farinelli L, Screpis D, Iacono V, Povegliano L, Bonomo M et al. (2022) Distal femoral osteotomy versus lateral unicompartmental arthroplasty for isolated lateral tibiofemoral osteoarthritis with intra-articular and extra-articular deformity: a propensity score-matched analysis. Knee Surg Relat Res 34(1):34.

    Article  Google Scholar 

  3. Husted H (2012) Fast-track hip and knee arthroplasty: clinical and organizational aspects. Acta Orthop 83(SUPPL 346):1–39

    Article  Google Scholar 

  4. Stambough JB, Nunley RM, Curry MC, Steger-May K, Clohisy JC (2015) Rapid recovery protocols for primary total hip arthroplasty can safely reduce length of stay without increasing readmissions. J Arthroplasty 30(4):521–526

    Article  Google Scholar 

  5. Kehlet H (2013) Fast-track hip and knee arthroplasty. Lancet 381(9878):1600–1602

    Article  Google Scholar 

  6. Aasvang EK, Luna IE, Kehlet H (2015) Challenges in postdischarge function and recovery: The case of fast-track hip and knee arthroplasty. Br J Anaesth 115(6):861–866

    Article  CAS  Google Scholar 

  7. Zhu S, Qian W, Jiang C, Ye C, Chen X (2017) Enhanced recovery after surgery for hip and knee arthroplasty: a systematic review and meta-analysis. Postgrad Med J 93(1106):736–742

    Article  Google Scholar 

  8. Pujol O, García B, Faura T, Nuevo M, Maculé F (2019) Results of a fast-track knee arthroplasty according to the experience of a multidisciplinary team. J Orthop 16(3):201–205

    Article  Google Scholar 

  9. Specht K, Kjaersgaard-Andersen P, Pedersen BD (2016) Patient experience in fast-track hip and knee arthroplasty—a qualitative study. J Clin Nurs 25(5–6):836–845

    Article  Google Scholar 

  10. Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H (2011) Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop 82(6):679–684

    Article  Google Scholar 

  11. Yoon RS, Nellans KW, Geller JA, Kim AD, Jacobs MR, Macaulay W (2010) Patient education before hip or knee arthroplasty lowers length of stay. J Arthroplasty 25(4):547–551

    Article  Google Scholar 

  12. Correia FD, Nogueira A, Magalhães I, Guimarães J, Moreira M, Barradas I et al. (2018) Home-based rehabilitation with a novel digital biofeedback system versus conventional in-person rehabilitation after total knee replacement: a feasibility study. Sci Rep.

    Article  Google Scholar 

  13. Cleary PD, Greenfield S, Mulley AG, Pauker SG, Schroeder SA, Wexler L et al. (1991) Variations in length of stay and outcomes for six medical and surgical conditions in Massachusetts and California. JAMA.

    Article  Google Scholar 

  14. Kim S, Losina E, Solomon DH, Wright J, Katz JN (2003) Effectiveness of clinical pathways for total knee and total hip arthroplasty: literature review. J Arthroplasty 18(1):69–74

    Article  Google Scholar 

  15. Khan SK, Malviya A, Muller SD, Carluke I, Partington PF, Emmerson KP et al. (2014) Reduced short-term complications and mortality following Enhanced Recovery primary hip and knee arthroplasty: results from 6,000 consecutive procedures. Acta Orthop 85(1):26–31

    Article  Google Scholar 

  16. Chughtai M, Kelly JJ, Newman JM, Sultan AA, Khlopas A, Sodhi N et al. (2019) The role of virtual rehabilitation in total and unicompartmental knee arthroplasty. J Knee Surg 32(1):105–110

    Article  Google Scholar 

  17. Patel S, Park H, Bonato P, Chan L, Rodgers M (2012) A review of wearable sensors and systems with application in rehabilitation. J Neuroeng Rehabil.

    Article  Google Scholar 

  18. Moffet H, Tousignant M, Nadeau S, Mérette C, Boissy P, Corriveau H et al. (2015) In-home telerehabilitation compared with faceto-face rehabilitation after total knee arthroplasty: a noninferiority randomized controlled trial. J Bone Joint Surg Am 97(14):1129–1141

    Article  Google Scholar 

  19. Russell TG, Buttrum P, Wootton R, Jull GA (2011) Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Series A 93(2):113–120

    Article  Google Scholar 

  20. Moffet H, Tousignant M, Nadeau S, Mérette C, Boissy P, Corriveau H et al. (2017) Patient satisfaction with in-home telerehabilitation after total knee arthroplasty: results from a randomized controlled trial. Telemed E-Health 23(2):80–87

    Article  Google Scholar 

  21. Rodríguez-Merchán EC, Gómez-Cardero P (2018) Unicompartmental knee arthroplasty: current indications, technical issues and results. EFORT Open Rev 3(6):363–373

    Article  Google Scholar 

  22. Saklad M (1941) Grading of patients for surgical procedures. Anesthesiology 2:281–284

    Article  Google Scholar 

  23. Thienpont E, Lavand’homme P, Kehlet H (2015) The constraints on day-case total knee arthroplasty: the fastest fast track. Bone Joint J. 97:40–44

    Article  Google Scholar 

  24. Husted H, Holm G, Jacobsen S (2008) Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 79(2):168–173

    Article  Google Scholar 

  25. Larsen K, Hansen TB, Søballe K, Kehlet H (2012) Patient-reported outcome after fast-track knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(6):1128–1135

    Article  Google Scholar 

  26. Malone PC, Agutter PS (2006) The aetiology of deep venous thrombosis. QJM 99(9):581–593

    Article  CAS  Google Scholar 

  27. Xing KH, Morrison G, Lim W, Douketis J, Odueyungbo A, Crowther M (2008) Has the incidence of deep vein thrombosis in patients undergoing total hip/knee arthroplasty changed over time? A systematic review of randomized controlled trials. Thromb Res 123(1):24–34

    Article  CAS  Google Scholar 

  28. Barastegui D, Robert I, Palau E, Haddad S, Reverte-Vinaixa M, Lorente L et al. (2017) Can local infiltration analgesia increase satisfaction in postoperative short-term pain control in total knee arthroplasty? J Orthop Surg 25(1):2309499017690461.

    Article  Google Scholar 

  29. Andersen L, Kehlet H (2014) Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review. Br J Anaesth 113(3):360–374

    Article  CAS  Google Scholar 

  30. Andersen LØ, Gaarn-Larsen L, Kristensen BB, Husted H, Otte KS, Kehlet H (2009) Subacute pain and function after fast-track hip and knee arthroplasty. Anaesthesia 64(5):508–513

    Article  CAS  Google Scholar 

  31. Wainwright TW, Kehlet H (2019) Fast-track hip and knee arthroplasty–have we reached the goal? Acta Orthop 90(1):3–5

    Article  Google Scholar 

  32. Büttner M, Mayer AM, Büchler B, Betz U, Drees P, Susanne S (2020) Economic analyses of fast-track total hip and knee arthroplasty: a systematic review. Eur J Orthop Surg Traumatol 30(1):67–74

    Article  Google Scholar 

  33. Ong KL, Lotke PA, Lau E, Manley MT, Kurtz SM (2015) Prevalence and costs of rehabilitation and physical therapy after primary TJA. J Arthroplasty 30(7):1121–1126

    Article  Google Scholar 

  34. Bozic KJ, Ward L, Vail TP, Maze M. Bundled payments in total joint arthroplasty: targeting opportunities for quality improvement and cost reduction knee. In: Clinical orthopaedics and related research, Vol. 472 Springer New York LLC; 2014. pp. 188–93.

  35. Lavernia CJ, D’Apuzzo MR, Hernandez VH, Lee DJ, Rossi MD (2006) Postdischarge costs in arthroplasty surgery. J Arthroplasty 21(6 SUPPL.):144–150

    Article  Google Scholar 

  36. Cottrell MA, Galea OA, O’Leary SP, Hill AJ, Russell TG (2017) Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil 31(5):625–638

    Article  Google Scholar 

  37. Tousignant M, Boissy P, Moffet H, Corriveau H, Cabana F, Marquis F et al. (2011) Patients’ satisfaction of healthcare services and perception with in-home telerehabilitation and physiotherapists’ satisfaction toward technology for post-knee arthroplasty: an embedded study in a randomized trial. Telemed E-Health 17(5):376–382

    Article  Google Scholar 

  38. Mashima PA, Birkmire-Peters DP, Syms MJ, Holtel MR, Burgess LPA, Peters LJ. Telehealth.

  39. Rawal N (2007) Postoperative pain treatment for ambulatory surgery. Best Pract Res Clin Anaesthesiol 21(1):129–148

    Article  Google Scholar 

  40. Wu CL, Berenholtz SM, Pronovost PJ, Fleisher LA (2002) Systematic review and analysis of postdischarge symptoms after outpatient surgery. Anesthesiology 96(4):994–1003.

    Article  Google Scholar 

  41. Husted H, Otte KS, Kristensen BB, Ørsnes T, Wong C, Kehlet H (2010) Low risk of thromboembolic complications after fast-track hip and knee arthroplasty. Acta Orthop 81(5):599–605

    Article  Google Scholar 

Download references


Not applicable.


Not applicable.

Author information

Authors and Affiliations



Conceptualization: A.P.G., M.S., and L.D.B.; methodology: L.D.B., M.S., and C.C.; investigation: L.D.B., M.S., and F.F.; writing—original draft preparation: L.D.B., M.S., and C.C.; writing—review and edit: A.P.G., M.S., and L.D.B.; supervision: A.P.G. and M.S. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Luca De Berardinis.

Ethics declarations

Ethics approval and consent to participate

Approved by the Institutional Review Board of Università Politecnica delle Marche, Ancona, Italy.

Consent for publication

Not applicable.

Competing interests

The authors declare no conflicts of interest with respect to the authorship and/or publication of this article.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De Berardinis, L., Senarighi, M., Ciccullo, C. et al. Fast-track surgery and telerehabilitation protocol in unicompartmental knee arthroplasty leads to superior outcomes when compared with the standard protocol: a propensity-matched pilot study. Knee Surg & Relat Res 34, 44 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: