<<Mdm Tay Mee Tiang underwent a knee replacement procedure under SGH’s enhanced recovery programme
in September 2020. She suffered from arthritis and walked with a limp for many years,
but is planning to have her other knee replaced soon.>>
An enhanced recovery
with a new surgical
technique for total knee
gets patients out of
hospital within the day.
Within hours of
her total knee
surgery, Mdm Tay
Mee Tiang was able to walk. The
64-year-old was discharged and
back in the comfort of her own
home the same day.
Typically, patients who
undergo knee replacement
surgery take three to four days
to recuperate at the hospital. But
Singapore General Hospital (SGH)
is able to shorten this to just 23
hours with its enhanced recovery
programme, which includes a new
surgical method. The hospital is
the first in Asia to offer same-day
total knee replacement surgery.
“The programme allows the
procedure to be done as a day
surgery and reduces postoperative
physical and psychological stress
to patients. This reduces their
recovery time and financial
burden,” said Dr Jerry Chen,
Consultant, Department of
Orthopaedic Surgery, SGH.
It is especially relevant during
the current pandemic, as a shorter
hospital stay for eligible patients
means a smaller chance of
catching the virus, he added.
The programme was piloted
in August 2019 with 50 patients.
Elective surgery resumed in
September 2020, and since then
to January 2021, more than 200
patients have benefited from the
programme. SGH sees about 1,800
total knee replacement patients a year, and about half could benefit
from the programme.
Total knee replacement
surgery is commonly performed
on patients with end-stage knee
arthritis. Patients eligible for
the programme attend a Joint
Replacement Class to prepare
them for what to expect during
and after the surgery.
Conducted by a multidisciplinary
team on the same day of their
pre-op assessment, the session
teaches them rehabilitation
exercises as well as pain
management and wound care.
This aims to ease patients’
anxiety, and to encourage them
to walk short distances with the
help of a physiotherapist soon
A new surgical technique
promotes better recovery as it
aligns the artificial knee to the
patient’s natural leg orientation.
technique restores the patient’s
anatomy to how it was before
arthritis had set in — whether
bow-legged, knock-kneed or
somewhere in between — and that
speeds up recovery,” said Dr Chen.
Post-op pain, nausea and
vomiting are minimised through
the use of spinal anaesthesia,
instead of general anaesthesia.
Returning to the hospital
for outpatient physiotherapy
and wound dressing changes
can be a worry for patients,
especially those without a carer
to bring them.
With the enhanced recovery
programme, patients continue
to be cared for after discharge.
Home visits are conducted by
physiotherapists in the first
week, during which they help
build patients’ confidence to get
up and go about with their new
knee. For instance, they walk
with them to nearby coffee shops
to buy their meals.
Community nurses visit in the
second week to check their wound
dressing, vital signs, and general
well-being. Should patients have
concerns, they can call a hotline.
experience pain and swelling of
the knee joint. These are to be
expected, and the nurses will remind them to ice their knee,”
said Dr Chen.
To date, none of the patients
on the programme have needed
readmission within 30 days.
Only patients who are generally
fit, and are able to walk
independently with a walking aid,
get in and out of bed on their
own, and climb stairs are eligible
for the programme.