Dr DM North, Orthopaedic Surgeon, Paarl
Winelands Knee Clinic | Dr. David North: specialist in Orthopaedic knee surgery
Total and partial knee replacements have proven to be successful, safe, and cost-effective in treating advanced osteoarthritis of the knee, leading to improvements in pain, function, and quality of life. There has been a steady increase in the incidence of knee replacements in the last two decades, with people wanting to stay more active as they age.
Enhanced recovery programs were developed to improve the outcomes of knee replacements and reduce complications, with studies showing higher morbidity and mortality with a prolonged hospital stay. As these programs developed, they resulted in shorter hospital stays, and building on the experience of these programs day case replacement programs developed. Improvements in the management of blood loss, and pain control have enabled day-case knee replacements to be possible.
Day-case knee replacement surgery, also known as outpatient knee replacement surgery, is a type of surgery where the patient is discharged from the hospital on the same day as the procedure. Potential benefits include a reduced hospital stay, recovery in the comfort of your home, and a reduction in the risk of complications that are associated with a prolonged hospital stay.
However, not all patients are eligible for day-case surgery, and appropriate patient selection and patient education are key to achieving good outcomes and ensuring patient safety.
As same-day discharge knee replacements are becoming more commonly performed the indications are increasing, with several scoring and classification systems used to select the appropriate patient.
Gogineni et al reported 3 main groups of factors including:
- Surgical factors
- Medical factors including bleeding disorders, liver cirrhosis and end-stage kidney disease
- Social factors, ensuring a strong social support system
Factors that lead to a favorable outcome are proper patient selection, with well-designed clinical and education pathways. When patients are selected appropriately, rates of complications and functional outcomes are similar to those seen in patients that stay in the hospital, with high patient satisfaction.
Success requires a multidisciplinary approach that includes extensive pre-operative patient education. Day-case knee replacements have been shown to be safe, and have a low rate of hospital readmissions, with a Royal College of Surgeons of England review showing lower readmission rates with day-case replacements when compared to inpatients. The clinical results are as good as in in-hospital patients. Patients have high satisfaction rates, with the ability to recover in the comfort and privacy of their own homes.
Day-case knee replacements have been found to be successful, safe, and cost-effective. The success is dependent on the coordination of the multidisciplinary team, standardised peri-operative protocol, optimal hospital discharge planning, and careful patient selection. With the focus being on minimising complications, maximising patient safety, and discharging patients to an appropriate and safe environment.
