Knee Replacement is one of the most successful Orthospaedic procedures. It has been practiced for over 30 years now. In modern times, there has been a huge improvement in terms of technology, surgical technique and understanding of biomechanics of the knee joint. Post-operative pain management and painless physiotherapy has brought about a lot of change in recovery. The prevalence of knee osteoarthritis is around 42% in women and 21% in men above 60 years. The number of knee replacements surgeries performed in India are around 1 lakh per year at present and it is expected to grow by 20% annually.
The fast track knee replacement is a new philosophy followed at Apollo Hospitals, Chennai. The main objective of this philosophy is to make the knee replacement procedure less painful, ensure faster recovery, painless physio and deliver trusted 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 as an outpatient by doing all the investigations and pre anaesthetic check-up as an OPD and patient getting admission just the night before surgery.
Surgery starts with single shot spinal anaesthesia without any additives which decreases the duration of spinal anaesthesia and patient regains his leg power within 2 to 3 hours. No tourniquet is used during the surgery, hence the release of anoxic and pain causing metabolites, which routinely happens after tourniquet release, doesn't happen here and hence post-operative pain is less.
Next part is 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. This decreases the chance of post-operative infection.
All our knee replacement surgeries are cruciate retaining method. Post operatively this particular technique helps to gain proprioceptive function and stair climbing, especially, is more natural. Ten days after the surgery, the patient can walk without any support. All our knee replacement surgeries are protocol driven.
Post-operative pain management involves multi modal techniques with femoral nerve block and no intra venous analgesics. There is no use of OPIODS in this technique which reduces drowsiness, vomiting and rarely respiratory depression.
The patient is made to walk 3 hours after the surgery with the help of support. By second day, the patient is able to walk to the wash room by himself and is independent. By the end of 10 days patient will be walking without help of any walking aid.
The Fast track knee replacement has the following advantages:
n Fast relief
n Minimal (or) no pain
n Trusted results
n Zero infection rate
n No painful physiotherapy
n Early discharge from the hospital
n Patient can resume social and recreational activities.
n Is cost effective
(Dr. Madan Mohan Reddy is Senior Consultant, Joint Replacement Surgery, Apollo Hospitals, Chennai. He is also the recipient of International Healthcare Awards 2016 by Time CyberMedia.)