京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22346号 / 医博第4587号 / 新制||医||1042(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 安達 泰治, 教授 森本 尚樹, 教授 福原 俊一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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<p><strong>Background: </strong>Total joint arthroplasty (TJA) is considered the treatment of choice to alleviate pain and improve function of patients with osteoarthritis. However,recent evidence suggests that a significant proportion of patients continue to report pain, or worsening of their symptoms well after their joint replacement. We call this chronic pain “<em>phantom joint pain</em>” as it persists despite the fact hat the affected joint has been replaced.</p> <p>Chronic pain of neuropathic origin may be a consequence of surgery or in patients with osteoarthritis (OA); there may be a combination of nociceptive and neuropathic pain (NP) mechanisms. As there are no definitive physiological indicators for NP or gold standards for diagnosis, Guidelines on Neuropathic Pain Assessment advocate the use of screening tools to evaluate the patient’s pain experiences and potentially characterize various pain features.</p> <p>Despite suggestions that phantom joint pain post TJA is a common problem there is limited information about its prevalence among Canadians. To date there are no studies that have characterized neuropathic vs. non- neuropathic chronic pain features in a TJA population.</p> <p><strong>Purpose: </strong>The purpose of this work was to determine the<em> </em>prevalence of chronic pain following total hip (THA) or knee (TKA) arthroplasty, and to identify the proportion of the cohort with chronic pain whose symptoms suggested the pain was of neuropathic origin. In addition we evaluated the ability of the NP Subscale of the McGill pain questionnaire [NP-MPQ (SF-2)] to identify individuals with NP vs. Non NP in the TJA population.</p> <p><strong>Methods:</strong> A retrospective cohort study (2-4 years post joint replacement) of 148 participants with primary unilateral TJAidentified from a large joint arthroplasty database (n=1143). Chronic pain was defined as post surgical pain reported 6-12 months following surgery to be 3 or higher (out of 5) on the Oxford Hip/Knee Scores, and that pain was the same or worse than reported preoperatively. A postal survey was used to administer the NP-MPQ (SF-2)and the Self-Administered Leeds Assessment of Neuropathic Signs and Symptoms (S–LANSS) (1.5-3.5 years post TJA). S-LANSS was the “non reference standard” for classification of neuropathic pain. Human research ethics approvals from Sunnybrook Health Sciences Centre and McMaster University/Hamilton Health Sciences were obtained prior to the study.</p> <p><strong>Results</strong>: The response rate to the postal survey to identify those with chronic pain of neuropathic origin was 53%. Thirteen percent of individuals experienced chronic pain; among individuals with chronic pain, neuropathic subtype was found in 28% (S-LANSS ≥ 12) - 43% [NP-MPQ (SF-2) ≥ 0.91]. Receiver Operating Characteristic (ROC) analysis for NP-MPQ (SF-2) yielded an area under the curve of 0.89 (95% CI: 0.82, 0.97). A cut off score of 0.91 NP-MPQ (SF-2),<strong> </strong>maximized sensitivity (89.5%) and specificity (75.0%). Our results revealed moderate correlation (r=0.56; 95% CI: 0.40, 0.68) between the S-LANSS and NP-MPQ (SF-2)scores in patients with NP post TJA.</p> <p><strong>Conclusion: </strong>Based on our results, a considerable percentage of individuals (13%) experience chronic pain following TKA and THA. Moreover, among individuals with chronic pain symptoms, a significant proportion (28-43%) of those experience pain that appears to have a neuropathic component, even 1.5 to 3.5 years following surgery.Overall prevalence of NP in TJA was 3.3 to 4.5%. The NP-MPQ (SF-2)subscale demonstrated “good” discriminatory ability, thus it might be useful in identifying patients with NP following TJA. Moderate association exists between the scales and this could affect prevalence rates in studies; or diagnosis of NP of individual patients based on the criterion used.</p> / Master of Science (MSc)

INTRODUÇÃO: O diagnóstico microbiológico das infecções em artroplastias é de fundamental importância para a definição da estratégia de uso dos antimicrobianos. As culturas microbiológicas convencionais apresentam elevados índices de falso-negativos, em especial, nas infecções crônicas, em que é frequente a presença do biofilme aderido ao implante. A utilização de amostras deste biofilme, viáveis à cultura, a partir de seu descolamento do implante pela técnica de sonicação, tem mostrado aumento da sensibilidade em publicações recentes. O objetivo deste estudo foi comparar os resultados das culturas microbiológicas de fragmentos de tecido periprotético, realizadas em meio sólido, àquelas obtidas pelo cultivo do líquido oriundo da sonicação do implante removido, semeado, inicialmente, em frascos de hemocultura e, posteriormente, em meio sólido. MÉTODOS: Neste estudo de análise descritiva, prospectivo e comparativo, 30 pacientes com diagnóstico de infecção em artroplastias de joelho ou quadril, com mais de 90 dias de história, tiveram seus implantes cirurgicamente removidos e foram coletadas seis amostras do tecido periprotético, de locais previamente determinados, para a realização de cultura microbiológica em meios sólidos. Simultaneamente, os implantes foram submetidos ao processo de sonicação e o material resultante foi injetado em frascos de hemocultura BD Bactec e submetidos ao processo de cultura automatizada. Todas as amostras foram pesquisadas quanto à presença de bactérias aeróbias, anaeróbias, micobactérias e fungos, e os resultados comparados por meio de análise estatística, em busca da superioridade de um método sobre o outro. Como objetivo secundário, buscou-se analisar quais os pontos de coleta do tecido periprotético teriam maior sensibilidade em suas culturas. RESULTADOS: Não houve diferenças estatisticamente significantes da amostra em relação ao gênero, patologia articular primária, tipo de artroplastia, localização do implante ou lateralidade. Em 17 casos (56,7%), houve uso de antimicrobianos no período de 15 dias que antecederam a retirada do implante. O método de cultura do fluido de sonicação mostrou sensibilidade de 86,7% e foi superior, de modo estatisticamente significante (P < 0,001), em relação à cultura dos fragmentos periprotéticos, cujos resultados tiveram sensibilidades entre 26,7 e 53,3%. O uso de antibioticoterapia recente não interferiu de modo estatisticamente significante na sensibilidade da cultura do líquido oriundo da sonicação. (P = 0,113). Quanto ao objetivo secundário, a coleta de fragmentos da membrana periprotética mostrou maior sensibilidade, estatisticamente significante, na comparação com três dos demais cinco pontos de coleta (P < 0,05). CONCLUSÕES: A cultura microbiológica do líquido obtido por sonicação dos implantes removidos de pacientes com diagnóstico de infecção periprotética e semeado inicialmente em frascos de hemocultura mostrou ter sensibilidade superior, estatisticamente significante, à cultura convencional de fragmentos do tecido periprotético semeados em meios sólidos. A cultura microbiológica da membrana periprotética mostrou ter maior sensibilidade em relação à maioria dos outros sítios que tiveram fragmentos de tecido periprotético pesquisados. / INTRODUCTION: Microbiological diagnosis in periprosthetic infection is of fundamental importance to define the most appropriate antimicrobial strategies. Conventional microbiological cultures have high rates of false negatives, especially in chronic infections, in which there is often the presence of biofilm attached to the implant. The use of samples of viable culturable biofilm taken from the detachment of the implant by sonication technique has been shown to increase the sensitivity in recent studies. The objective of this study was to compare the results of microbiological cultures of periprosthetic tissue fragments, made in a solid medium, to those obtained through the cultivation of the liquid coming from the sonication of the removed implant initially seeded in blood culture bottles and later in solid medium. METHODS: Using descriptive, prospective and comparative analysis, thirty patients with a diagnosis of infected knee or hip arthroplasty, with more than ninety days of history, had their implants surgically removed. Six periprosthetic tissue samples, collected at predetermined places, were used for microbiological culture on solid media. Simultaneously, the implants were subjected to the sonication process, and the resulting material was injected into vials of BD Bactec blood cultures and subjected to an automated culture process. All samples were screened for the presence of aerobic bacteria, anaerobes, mycobacteria and fungi and the results compared by statistical analysis to find the superiority of one method over the other. As a secondary objective, this study sought to analyze which of the periprosthetic tissue collecting points would have greater sensitivity in their cultures. RESULTS: There were no statistically significant differences in the sample as related to gender, primary joint pathology, type of arthroplasty, implant location or laterality. In seventeen cases (56.7%), antimicrobials were used within the 15-day period leading up to the removal of the implant. The sonication culture fluid showed a sensitivity of 86.7% and was higher, statistically significant (P < 0.001) in relation to the culture of periprosthetic fragments, where results displayed sensitivities between 26.7 and 53.3%. The use of recent antibiotic therapy did not affect the sensitivity of the liquid coming from the sonication culture, which was not statistically significant (P = 0.113). As for the secondary objective, the collection of periprosthetic membrane fragments showed higher sensitivity, statistically significant (P < 0.05), as compared to three of the remaining five collecting points. CONCLUSIONS: The microbiological culture liquid obtained by sonication of the implants removed from patients with diagnosis of periprosthetic infection and initially seeded in blood culture bottles was shown to have superior sensitivity, statistically significancy, as compared to conventional culture of the periprosthetic tissue fragments seeded on solid media. The microbiological culture of the periprosthetic membrane seems to be more sensitive compared to most other sites that had periprosthetic tissue fragments surveyed

La pose d’une prothèse totale de genou (PTG) se fait selon la technique d’alignement mécanique (AM) qui corrige les déformations constitutionnelles du membre pour créer un membre rectiligne. La survie à long terme des implants est excellente mais les résultats fonctionnels sont décevants avec notamment de nombreux symptômes résiduels. Une nouvelle technique chirurgicale, l’alignement cinématique (AC), vise à rétablir l’anatomie constitutionnelle pré-arthrosique du genou, et permet une amélioration des résultats fonctionnels des PTG. Cette technique est actuellement réalisée avec des implants destinés à un positionnement mécanique, et qui ont un design trochléen ne reproduisant pas l'anatomie trochléaire native. Ceci pourrait affecter la biomécanique de l’articulation patello-fémorale et donc rendre les résultats fonctionnels des PTG cinématiques non optimal. Ce travail vise à démontrer 1) les limitations de la technique mécanique, 2) la fiabilité de la technique cinématique pour le positionnement de l’implant fémoral, et 3) que les implants actuels ne permettent pas une restauration de l’anatomie trochléenne des patients. / The conventional technique for TKA, namely mechanical alignment (MA), does not preserve the constitutional limb anatomy but systematically creates a straight limb. Excellent long-term implant survivorship has been reported, but functional outcomes are disappointing. To solve this problem, an alternative technique for TKA, namely kinematic alignment (KA), has recently been promoted and aims at restoring the constitutional (pre-arthritic) knee anatomy and laxity. Mid-term outcomes have shown excellent functional outcomes with this new KA technique. However, KA technique is currently done with TKA implants designed to be mechanically inserted. Their trochlea design does not reproduce the native trochlear anatomy, which could lead to increased rate of patellar complications with KA TKA. This work aims at demonstrating technical limitations of MA technique, good reproducibility of KA technique, and inappropriateness of current implant to restore patient trochlea anatomy.

INTRODUÇÃO: O diagnóstico microbiológico das infecções em artroplastias é de fundamental importância para a definição da estratégia de uso dos antimicrobianos. As culturas microbiológicas convencionais apresentam elevados índices de falso-negativos, em especial, nas infecções crônicas, em que é frequente a presença do biofilme aderido ao implante. A utilização de amostras deste biofilme, viáveis à cultura, a partir de seu descolamento do implante pela técnica de sonicação, tem mostrado aumento da sensibilidade em publicações recentes. O objetivo deste estudo foi comparar os resultados das culturas microbiológicas de fragmentos de tecido periprotético, realizadas em meio sólido, àquelas obtidas pelo cultivo do líquido oriundo da sonicação do implante removido, semeado, inicialmente, em frascos de hemocultura e, posteriormente, em meio sólido. MÉTODOS: Neste estudo de análise descritiva, prospectivo e comparativo, 30 pacientes com diagnóstico de infecção em artroplastias de joelho ou quadril, com mais de 90 dias de história, tiveram seus implantes cirurgicamente removidos e foram coletadas seis amostras do tecido periprotético, de locais previamente determinados, para a realização de cultura microbiológica em meios sólidos. Simultaneamente, os implantes foram submetidos ao processo de sonicação e o material resultante foi injetado em frascos de hemocultura BD Bactec e submetidos ao processo de cultura automatizada. Todas as amostras foram pesquisadas quanto à presença de bactérias aeróbias, anaeróbias, micobactérias e fungos, e os resultados comparados por meio de análise estatística, em busca da superioridade de um método sobre o outro. Como objetivo secundário, buscou-se analisar quais os pontos de coleta do tecido periprotético teriam maior sensibilidade em suas culturas. RESULTADOS: Não houve diferenças estatisticamente significantes da amostra em relação ao gênero, patologia articular primária, tipo de artroplastia, localização do implante ou lateralidade. Em 17 casos (56,7%), houve uso de antimicrobianos no período de 15 dias que antecederam a retirada do implante. O método de cultura do fluido de sonicação mostrou sensibilidade de 86,7% e foi superior, de modo estatisticamente significante (P < 0,001), em relação à cultura dos fragmentos periprotéticos, cujos resultados tiveram sensibilidades entre 26,7 e 53,3%. O uso de antibioticoterapia recente não interferiu de modo estatisticamente significante na sensibilidade da cultura do líquido oriundo da sonicação. (P = 0,113). Quanto ao objetivo secundário, a coleta de fragmentos da membrana periprotética mostrou maior sensibilidade, estatisticamente significante, na comparação com três dos demais cinco pontos de coleta (P < 0,05). CONCLUSÕES: A cultura microbiológica do líquido obtido por sonicação dos implantes removidos de pacientes com diagnóstico de infecção periprotética e semeado inicialmente em frascos de hemocultura mostrou ter sensibilidade superior, estatisticamente significante, à cultura convencional de fragmentos do tecido periprotético semeados em meios sólidos. A cultura microbiológica da membrana periprotética mostrou ter maior sensibilidade em relação à maioria dos outros sítios que tiveram fragmentos de tecido periprotético pesquisados. / INTRODUCTION: Microbiological diagnosis in periprosthetic infection is of fundamental importance to define the most appropriate antimicrobial strategies. Conventional microbiological cultures have high rates of false negatives, especially in chronic infections, in which there is often the presence of biofilm attached to the implant. The use of samples of viable culturable biofilm taken from the detachment of the implant by sonication technique has been shown to increase the sensitivity in recent studies. The objective of this study was to compare the results of microbiological cultures of periprosthetic tissue fragments, made in a solid medium, to those obtained through the cultivation of the liquid coming from the sonication of the removed implant initially seeded in blood culture bottles and later in solid medium. METHODS: Using descriptive, prospective and comparative analysis, thirty patients with a diagnosis of infected knee or hip arthroplasty, with more than ninety days of history, had their implants surgically removed. Six periprosthetic tissue samples, collected at predetermined places, were used for microbiological culture on solid media. Simultaneously, the implants were subjected to the sonication process, and the resulting material was injected into vials of BD Bactec blood cultures and subjected to an automated culture process. All samples were screened for the presence of aerobic bacteria, anaerobes, mycobacteria and fungi and the results compared by statistical analysis to find the superiority of one method over the other. As a secondary objective, this study sought to analyze which of the periprosthetic tissue collecting points would have greater sensitivity in their cultures. RESULTS: There were no statistically significant differences in the sample as related to gender, primary joint pathology, type of arthroplasty, implant location or laterality. In seventeen cases (56.7%), antimicrobials were used within the 15-day period leading up to the removal of the implant. The sonication culture fluid showed a sensitivity of 86.7% and was higher, statistically significant (P < 0.001) in relation to the culture of periprosthetic fragments, where results displayed sensitivities between 26.7 and 53.3%. The use of recent antibiotic therapy did not affect the sensitivity of the liquid coming from the sonication culture, which was not statistically significant (P = 0.113). As for the secondary objective, the collection of periprosthetic membrane fragments showed higher sensitivity, statistically significant (P < 0.05), as compared to three of the remaining five collecting points. CONCLUSIONS: The microbiological culture liquid obtained by sonication of the implants removed from patients with diagnosis of periprosthetic infection and initially seeded in blood culture bottles was shown to have superior sensitivity, statistically significancy, as compared to conventional culture of the periprosthetic tissue fragments seeded on solid media. The microbiological culture of the periprosthetic membrane seems to be more sensitive compared to most other sites that had periprosthetic tissue fragments surveyed

Introduction: Osteoarthrosis (OA) of the knee is a degenerative and chronic disease that promotes intense pain and often compromises the elderly population. With the severity of OA and the lack of success of conventional methods, Total Knee Arthroplasty (KTA) has been the most frequently used treatment, however, in some patients pain persists. Therefore, to better understand the pain, it is necessary to use somatosensory and functional tests. Objective: To evaluate the Pressure Pain Threshold (LDP) of patients with OA and submitted to TKA, as well as to analyze the association of pain intensity with functional factors. Methods: A case-control study was carried out on 40 subjects, selected for convenience at the Specialized Center for Orthopedics and Trauma (CEOT), divided into two groups: TKA group consisting of 20 patients operated on, being evaluated in three phases: preoperative , six and 12 months; and the control group comprised of 20 healthy, asymptomatic, paired subjects by sex and age, evaluated in a single moment. The LDP was performed through the digital pressure algometer. The intensity of pain was measured on the numerical scale from 0 to 10, the muscular strength assessed by the digital manual dynamometer. Range of motion obtained by the fleximeter. Static balance measured by the baropodometer and the speed test used to measure gait speed. Results: It presented statistical difference between the control group and TKA in all peripatellar and tibial points (P) (p <0.002). P4, P5, P5, P6, P8 and P9 (p <0.05), and six and 12 months were significant at P4, P5, P6, P8 and P9 (p <0.05) and Preoperative period and 12 months in P9 (p <0.05). In the comparison between the P at each stage of the evaluation, only significant changes were observed between P3 and P6 (p <0.05), P4 and P6 (p <0.005). Correlations of moderate to strong and inversely proportional between pain in movement and flexor strength (r = - 0.46), knee extensors (r = -0.49), hip abductors (r = -0.59) And gait velocity (r = -0.6), in the preoperative phase. Conclusion: In the preoperative phase there was lower LDP, due to central and peripheral sensitization due to OA chronicity. At six months post-operatively, he found a decrease in pain, which could be related to the efficacy of TKA and rehabilitation. Similar to the pre-surgical phase, at 12 months, LDP decreased, which may be linked to the central pain sensitization mechanism, contributing negatively to the decline in muscle strength and gait velocity. / Introdução: A osteoartrose (OA) do joelho é uma doença degenerativa, crônica que promove dor intensa e frequentemente compromete a população idosa. Com a gravidade da OA e a falta de sucesso dos métodos convencionais, a Artroplastia Total do Joelho (ATJ) tem sido o tratamento cirúrgico mais utilizado, para melhora da função biomecânica e da qualidade de vida. No entanto, alguns pacientes, apresentam a persistência de dor. Portanto, para melhor compreensão do quadro álgico torna-se necessário a utilização de testes somatossensoriais e funcionais. Objetivo: Avaliar o Limiar de Dor por Pressão (LDP) dos pacientes com OA e submetidos à ATJ, bem como analisar a associação da intensidade de dor com os fatores funcionais. Métodos: Estudo caso-controle, participaram 40 sujeitos, selecionados por conveniência no Centro de Especialidade em Ortopedia e Trauma (CEOT), divididos em dois grupos: grupo ATJ formado por 20 pacientes operados, sendo avaliados em três fases: pré-operatória, seis e 12 meses; e o grupo controle formado por 20 sujeitos saudáveis, assintomáticos, pareados por sexo e idade, avaliados em um único momento. O LDP foi realizado pelo algômetro de pressão digital e aplicado perpendicularmente a pele em seis pontos peripatelares (P1, P2, P3, P4, P5 e P6) e três pontos tibiais (P7, P8 e P9). A intensidade de dor foi mensurada na escala numérica de zero a 10. A força muscular avaliada pelo dinamômetro manual digital. A amplitude de movimento obtida pelo flexímetro. Equilíbrio estático mensurado pelo baropodômetro e utilizado o speed test para medir a velocidade da marcha. Resultados: O grupo controle apresentou maior LDP, com diferença estatística, comparado ao grupo ATJ em todos os pontos (P) peripatelares e tibiais (p< 0,002). Na fase pré-operatória houve menor LDP em relação a fase de seis meses nos P3, P4, P5, P6, P8 e P9 (p<0,05). Aos 12 meses ocorreu uma redução do LDP nos P4, P5, P6, P8 e P9 (p<0,05) quando relacionado a fase de seis meses. Na comparação entre os P em cada fase da avaliação, observou que somente na fase pré-operatória, o LDP foi menor no P6 em relação aos P3 e P4 (p<0,005). Foram encontradas correlações de moderada a forte, e inversamente proporcional, entre dor em movimento e força dos flexores (r = -0,46), extensores do joelho (r = -0,49), abdutores do quadril (r = -0,59) e velocidade da marcha (r = -0,6), na fase pré-operatória. Conclusão: Na fase pré-operatória houve menor LDP, provavelmente, em virtude da cronicidade da OA e consequentemente da sensibilização central e periférica. Aos seis meses de pós-operatório, encontrou redução do quadro álgico, podendo relacionar à eficácia da ATJ e da reabilitação. Semelhante à fase pré-cirúrgica, aos 12 meses, o LDP diminuiu, possivelmente estando atrelado ao mecanismo de sensibilização central de dor, contribuindo negativamente para o declínio da força muscular e da velocidade média da marcha.

Background: Patient reports of pain and function are used to inform the need for and timing of total knee replacement (TKR) and evaluate TKR outcomes. This dissertation compared measurement properties of commonly-used patient surveys in TKR and explored ways to develop more efficient knee-specific function measures. Methods: 1,179 FORCE-TJR patients (mean age=66.1, 61% female) completed questionnaires before and 6 months after TKR. Patient surveys included the knee-specific Knee injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and generic SF-36 Health Survey. Tests of KOOS and WOMAC measurement properties included evaluations of scaling assumptions and reliability. Item response theory methods were used to calibrate 22 KOOS function items in one item bank; simulated computerized adaptive tests (CAT) then were used to evaluate shorter function scores customized for each patient. Validity and responsiveness of measures varying in attributes (knee-specific versus generic, longer versus shorter, CAT versus fixed-length) were compared. Results: KOOS and WOMAC scales generally met tests of scaling assumptions, although many pain items were equally strong measures of pain and physical function. Internal consistency reliability of KOOS and WOMAC scales exceeded minimum levels of 0.70 recommended for group-level comparisons across sociodemographic and clinical subgroups. Function items could be calibrated in one item bank. CAT simulations indicated that reliable knee-specific function scores could be estimated for most patients with a 55-86% reduction in respondent burden, but one-third could not achieve a reliable (≥ 0.95) CAT score post-TKR because the item bank did not include enough items vi measuring high function levels. KOOS and WOMAC scales were valid and responsive. Short function scales and CATs were as valid and responsive as longer KOOS and WOMAC function scales. The KOOS Quality of Life (QOL) scale and SF-36 Physical Component Summary discriminated best among groups evaluating themselves as improved, same or worse at 6 months. Conclusions: Results support use of the KOOS and WOMAC in TKR. Improved knee-specific function measures require new items that measure higher function levels. TKR outcomes should be evaluated with a knee-specific quality of life scale such as KOOS QOL, as well as knee-specific measures of pain and function and generic health measures.

Bakgrund: Antalet personer som genomgår knäartroplastik ökar markant i västvärlden samtidigt som den genomsnittliga vårdtiden efter genomgången knäartroplastik minskar. Tidigare forskning visar att ingreppet är väl lämpat för dagkirurgi. Det är trots detta svårt att hitta kvalitativ forskning som beskriver patientens upplevelse av att ha genomgått en knäartroplastik i dagkirurgi. Syfte: Syftet med denna studie var att beskriva patientens upplevelse av att genomgå en unikompartmentell knäartroplastik (UKA) i dagkirurgi. Metod: Denna kvalitativa intervjustudie inkluderade åtta personer som genomgått en UKA i dagkirurgi mellan 2017 och 2020. Semistrukturerade intervjuer genomfördes i mars 2020 med stöd av en intervjuguide. Deltagarna fick berätta om upplevelsen av att ha genomgått en UKA i dagkirurgi. Resultat: Resultatet visar att de flesta deltagarna var nöjda med att ha genomgått operationen i dagkirurgi. Upplevelsen av trygghet i samband med den tidiga hemgången hade ett nära samband med uppföljning samt informationen inför operationen som gav deltagarna verktyg för att hantera såväl smärta som aktiviteter i det dagliga livet (ADL) och rehabilitering i hemmet. Konklusion: För att känna trygghet i samband med att genomgå UKA i dagkirurgi har utförlig information samt tidig uppföljning en central roll i resultatet av patientens upplevelse.