Singapore, 10 February 2021 – Singapore General Hospital (SGH) is the only hospital in Asia, and one of the few hospitals in the world to offer total knee replacement (TKR) as a day surgery. Under the enhanced recovery programme, eligible patients have been able to go home within 23 hours of surgery instead of the average four days hospital stay in the past.
The 64-year-old Mdm Tay MT is one of them. She has had two TKRs done just months apart - one for her left knee last September, followed by another in December for her right knee. On both occasions, Mdm Tay went home on the same day after the procedure. She needed both her knees replaced due to osteoarthritis, a condition commonly associated with ageing. In fact, about 90 per cent of patients in SGH who require TKR suffers from osteoarthritis.
“Total knee replacement is the most common orthopaedic surgery performed in many developed countries. The enhanced recovery programme allows TKR to be done as a day surgery in Singapore General Hospital due to coordinated efforts from a multi-disciplinary care team involving doctors, nurses, and physiotherapists. This is especially relevant during the current COVID-19 pandemic as a shorter hospital stay for eligible patients means a lower risk of possible exposure to the virus,” according to Dr Jerry Chen, Consultant, Department of Orthopaedic Surgery.
Previously, patients were taught rehabilitation exercises, pain management, and wound care only after their surgery. Now, they learn these during a Joint Replacement Class that is conducted on the same day as his/her pre-operative assessment. This allows them to have more time to learn and familiarise themselves with the post-surgery process, which in turn helps to speed up recovery.
TKR can be performed using the conventional mechanical alignment technique or a newer kinematic alignment technique. The surgery is commonly performed under regional anaesthesia, reducing the incidence of postoperative vomiting usually associated with general anaesthesia. A nerve block is also given to minimise pain, without affecting muscle strength required for physiotherapy after surgery.
Multi-disciplinary care of the patient continues even after discharge. There will be home visits by SGH nurses and physiotherapists to assess patients’ recovery in the first two weeks. If patients prefer, they can also opt for the newly launched tele-physiotherapy sessions, or a video consultation with the surgeon for their review.
SGH performs the highest number of TKR in the country, with 1,800 surgeries done every year and this number is expected to increase exponentially with the rapidly ageing population. About 40 patients have benefitted from the same-day TKR enhanced recovery programme each month since its launch in September 2020 after a small pilot trial in the previous year. Day surgeries such as knee replacement will be performed at the Elective Care Centre when it is completed.
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