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Short-Stay and Fast-Track Knee Replacement

What is Short-Stay and Fast-Track Knee Replacement?

Short-stay and fast-track knee replacement is a minimally invasive surgical procedure in which the worn-out or damaged surfaces of the knee joint are removed and replaced with prostheses. It is a multidisciplinary approach for knee treatment in which patients are mobilized as early as possible to achieve a faster and better recovery without compromising quality. The main goal of this treatment method is to reduce the necessity of hospitalization to not more than 3 days while maintaining very high patient satisfaction and few complications.

Anatomy of the Knee

The knee is made up of the femur (thighbone), the tibia (shinbone), and the patella (kneecap). The lower end of the thighbone meets the upper end of the shinbone at the knee joint. A small disk of bone called the patella (kneecap) rests on a groove on the front side of the femoral end. A bone of the lower leg (fibula) forms a joint with the shinbone. The bones are held together by protective tissues, ligaments, tendons, and muscles. Synovial fluid within the joint aids in the smooth movement of the bones over one another. The meniscus, a soft crescent-shaped area of cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion.

Indications for Short-stay and Fast-Track Knee Replacement

Some of the common indications for short-stay and fast-track knee replacement include:

  • Osteoarthritis of the knee joint
  • Rheumatoid arthritis
  • Knee deformity with loss of cartilage and pain
  • Injury or fracture of the knee
  • Gouty arthritis
  • Instability of the knee
  • Significant pain, swelling, and stiffness affecting mobility and quality of life

Preparation for Short-Stay and Fast-Track Knee Replacement

Preoperative preparation for short-stay and fast-track knee replacement will involve the following steps:

  • A thorough examination by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
  • You should refrain from alcohol or tobacco at least 24 hours prior to surgery.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • Arrange for someone to drive you home as you will not be able to drive yourself post surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Short-Stay and Fast-Track Knee Replacement

The procedure is mostly performed arthroscopically under local, spinal or general anesthesia and involves the following steps:

  • After adequately sterilizing the surgical area, your surgeon makes 2 to 3 small key-hole incisions around the knee.
  • An arthroscope, a narrow tube with a tiny video camera on the end, is inserted through one of the incisions to view the knee joint. The structures inside the knee are visible to your surgeon on a video monitor in the operating room.
  • Small miniature instruments are inserted through other small incisions and the supporting structures of the knee are gently moved out of the way, allowing removal of damaged cartilage and bone tissue from the surfaces of the femur and tibia.
  • Your surgeon prepares these surfaces appropriately to insert specifically-sized prosthetic components to your knee joint, which are secured with the use of bone cement or screws.
  • With all the new components in place, the knee joint is tested through its range of motion.
  • All surrounding tissues and structures are restored to their normal anatomic position and the scope and instruments are removed.
  • Finally, the incisions are closed with sutures and sterile dressings are applied.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery will involve the following steps:

  • You will be transferred to the recovery area to be monitored until you are awake from the anesthesia.
  • Your nurse will monitor your blood oxygen level and other vital signs as you recover.
  • You may notice some pain, swelling, and discomfort in the knee area. Pain and anti-inflammatory medications are provided as needed.
  • Medications will also be prescribed as needed for symptoms associated with anesthesia, such as vomiting and nausea.
  • Antibiotics are prescribed to address the risk of surgery-related infection.
  • Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
  • You will be placed on crutches for the first few weeks with instructions on restricted weight-bearing. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
  • Use of a continuous passive motion machine (CPM) at home is advised during the first few weeks to aid in the constant movement of the knee joint under a controlled range of motion.
  • You are advised to keep your leg elevated while resting to prevent swelling and pain.
  • Refrain from smoking as it can negatively affect the healing process.
  • Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
  • Refrain from strenuous activities and lifting heavy weights for the first couple of months. Gradual increase in activities over a period of time is recommended.
  • An individualized physical therapy protocol is designed to help strengthen your knee muscles and optimize knee function.
  • You will be able to resume your normal activities in a couple of months; however, return to sports may take 4 to 6 months.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Advantages of Short-Stay and Fast-Track Knee Replacement

Some of the advantages of short-stay and fast-track knee replacement include:

  • Minimal surgical incision
  • Less postoperative pain
  • Short recovery period
  • Shorter hospital stays
  • Minimal blood loss
  • Minimal damage to surrounding tissues

Risks and Complications

Short-stay and fast-track knee replacement is relatively a safe procedure; however, as with any procedure, it does carry some risks, including:

  • Blood clots
  • Infection
  • Bleeding
  • Injury to nerves and blood vessels
  • Implant loosening
  • The need for revision surgery (to address a faulty or problematic prior implant)
  • American Academy of Orthopaedic Surgeons
  • AAHKS
  • UCI School of Medicine, Department of Orthopaedic Surgery, Orange