Fast Track Knee Replacement
Knee Replacement is one of the most successful Orthopaedic procedures and has been practised over the past 30 years. There has been a huge improvement in terms of technology, surgical technique and understanding of the biomechanics of knee joints. Post-operative pain management and painless physiotherapy has made lot of difference in recovery. The prevalence of knee osteoarthritis is around 42% in women and 21% in men above the age of 60 years. The number of knee replacements that happen in India are around 1 lakh per year at present and it is expected to grow by 20% annually.
Fast track knee replacement is a new philosophy that is being followed at Apollo Hospitals. The main objective of this philosophy is to make knee replacement procedure less painful, have quicker recovery, provide physiotherapy with no pain and deliver good results. We follow a multi-modal approach for knee replacement with less surgical time, early mobilization, discharge and recovery.
The concept of fast track knee replacement starts by doing all the investigations and pre anaesthetic check-up as an outpatient procedure. The patient gets admitted just a night before surgery. Surgery starts with single shot spinal anaesthesia which decreases the duration of spinal anaesthesia and the patient regains his leg power within two to three hours. No tourniquet is used during the surgery and hence the release of anoxic and pain causing metabolites (which happens after tourniquet release) doesn’t happen here. This results in reduced post-operative pain.
Following this, is the minimally invasive surgery. This involves small skin incision, minimal tissue dissection and less blood loss. This decreases post-operative pain and in turn helps in early mobilization and recovery. As a part of fast track knee replacement, no surgical wound drain and no urinary catheter is used which reduces the chance of post-operative infection.
All our knee replacement surgeries follow the cruciate retaining method and are protocol driven. Post operatively, this particular technique helps to gain proprioceptive function and stair climbing specifically is easier. Ten days after the surgery these patients can walk without any support.
Post-operative pain management involves multi modal techniques with femoral nerve block and no intra venous analgesics. There is no use of opioids for pain relief in this process, which reduces drowsiness, vomiting and avoids complications such as respiratory depression. Patient is made to walk 3 hours after the surgery with the help of support. By the second day after surgery, the patient is able to walk to wash room and is independent. By the end of 10 days, the patient will be walking without help of any walking aid.
In summary, Fast track knee replacement has the following advantages:
- Faster recovery
- Minimal (or) no pain
- Trusted results
- Zero infection rate
- No painful physiotherapy
- Early discharge from the hospital
- Patient can resume social and recreational activates soon
- Very cost effective.
