Impeding Factors of Early Rehabilitation Postoperatively After Rheumatoid Toe Arthroplasty: A Single-Center Retrospective Cohort Study

Introduction: Previous studies explored the benefits related to early ambulation postoperatively, but few focused on patients with rheumatoid arthritis (RA). We retrospectively evaluated the incidence and predictors of the inability to begin walking on the first postoperative day (POD) after toe arthroplasty for rheumatoid arthritis.

Methods: RA patients who underwent toe arthroplasty at one hospital were retrospectively reviewed. A total of 300 patients were included and divided into two groups: possible group (n = 191), who were able to walk on the first POD, and impossible group (n = 109), who were unable to walk on the first POD. Data were analyzed using odds ratios (OR) with 95% confidence intervals (CI) between various patient factors and the impossible group with logistic regression analysis.

Results: The incidence of postoperative nausea and vomiting before rehabilitation was significantly associated with the infeasibility of walking rehabilitation on the first POD [OR = 2.43, 95% CI 1.22-4.14, P = 0.003]. The number of rescue analgesics administered before rehabilitation and the supplementation of peripheral nerve block was also associated with the infeasibility of walking rehabilitation on the first POD [OR = 1.29, 95% CI 1.04-1.59, P = 0.003; OR = 0.41, 95% CI 0.20-0.79, P = 0.010, respectively].

Conclusion: The incidence of postoperative nausea and vomiting and inadequate postoperative pain management hindered early rehabilitation. Adding peripheral nerve block to general anesthesia had an advantage for postoperative rehabilitation after toe arthroplasty for rheumatoid arthritis.

Keywords: Arthroplasty; Pain management; Peripheral nerve block; Postoperative pain; Rehabilitation; Rheumatoid arthritis; Walking rehabilitation.