Written by Mr Kirti Moholkar for Doctify
The need for a knee replacement can be brought on by a number of conditions. Rheumatoid arthritis, gout and injury are just a few of common reasons for the surgery.
Recovery can vary on a case to case basis but the sooner you’re able to get up and about, the better. Orthopaedic surgeon, Mr Kirti Moholkar of the Droitwich Knee Clinic has implemented the ‘Get Better Soon’ programme to aid recovery. Read on to find out more.
What is the ‘Get Better Soon’ programme?
The benefits of implementing ‘Get Better Soon’ (GBS) enhanced recovery programme for knee replacement patients are well established.
Unfortunately, these benefits are not yet reaching many patients.
Droitwich Knee Clinic is among the relatively few units which have been able to successfully implement enhanced recovery programme for knee replacement since 2005. It is heartening to see the clinic achieve excellent results by implementing the principles of enhanced recovery for knee replacement patients. Discharging the patient the day after the knee replacement is commonly achieved.
As a result of the GBS programme, there is a significant reduction in the length of hospital stay. There are also reduced rates of infection and complications as well as better pain management after surgery compared to the traditional practices.
This enhanced recovery programme begins at the pre-operative phase in the outpatient department, progresses through intra-operative and post-operative care, and finally to discharge of patients home.
Pre-Operative Phase
If all non-invasive treatments have been exhausted, and the decision for a knee replacement surgery has been made, a pre-assessment or health screening is done. It includes –
- Health questionnaire
- Body Mass Index (BMI)
- Heart Rate (HR)
- Blood Pressure (BP) measurements
This mini pre-assessment helps to identify high-risk patients. It also prevents the problem of late identification and cancellation on the day of surgery or during formal pre-assessment.
Patient Education Phase
The success of the GBS enhanced recovery programme relies heavily on patient education and expectation management. Standardised information, for example, leaflets given during pre-assessment, can help reduce patient anxiety and manage expectations. Physiotherapists and pain specialist nurses demonstrate what the patient can expect during recovery. Patients are educated about mobilisation, followed by a stairs assessment before discharge. They also demonstrate pre-operative strengthening exercises that have been shown to speed up and ease recovery.
Pre-Surgery Phase
Patients are given premedication prior to surgery, so that the dose increases to a treatment level in the postoperative period when it is needed most. This replaces patient controlled analgesia or PCA pumps which may cause nausea or postural hypotension resulting in delayed rehabilitation and increased length of stay.
Intra-Operative Phase
A standardised analgesia regimen is prescribed to all patients unless contraindicated. This avoids the use of PCA or Morphine based medications and associated side effects.
Rehabilitation
Physiotherapy is vital in the enhanced recovery programme. Physiotherapy treatment focuses on early mobilisation and range of motion. Muscle strengthening exercises are also performed. The average length of stay following a total knee replacement is 1-3 days, and varies depending on the individual health and motivation. If you are a motivated individual, please ask for the GBS Enhanced recovery pathway treatment.
After the surgery, the patient can walk independently with crutches or sticks, able to safely negotiate stairs and have at least 90 degrees of knee bend within 2 hours of surgery. The physiotherapist will also go through a home exercise programme usually twice on the day of surgery and twice the following day of surgery which you will be expected to continue at home.
