Ninety-six percent of minimally invasive knee replacement patients leave same day, no complication

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Rush University Medical Center

20.12.2005



Ninety-six percent of minimally invasive knee replacement patients

leave same day, no complication

’Pre-surgical’ team approach gets patients ready to leave same day

Orthopedic surgeons at Rush University Medical Center found that 96

percent of patients who had minimally invasive total knee replacement

surgery were able to go home the same day, without complications-many

walking out unassisted or with a cane. These results were published

in the October issue of the Journal of Arthroplasty.

Lead author surgeon A. Berger says it’s not just the

surgeon’s skills and techniques that help patients avoid a hospital

stay.

" It’s a comprehensive management pathway helps the patient avoid an

overnight stay. It’s optimal sequencing and timing of interventions

by the nursing, physical therapy, anesthesia surgical team; it’s a

team approach of equally weighted preoperative, intraoperative, and

postoperative care. "

Patients meet with the physical therapist and nurse prior to surgery.

" The nurse time is invaluable to patient before going into surgery, "

says Berger. " They attend a class led by with a nurse where potential

surgical complications and postoperative care are discussed.

Patients spend an hour learning about the surgery, asking questions

about pain, recovery and surgery. We reassure patients that their

pain will be controlled, that they will be carefully monitored for

the occurrence of complications or delayed recovery due to early

discharge, and explain how will be able to move around independently

after surgery.

After class with the nurse, patients have a physical therapy session

for instruction in gait training with crutches and a cane. An

internist also evaluates patients as part of our hospital’s policy.

Lastly, the hospital discharge planner calls the patient at home

before surgery to make sure all someone can take him or her home

after surgery. "

The 50 study patients (20 female, 30 males) had surgery between

August 2003 and August 2004. The average age was 68 years old,

average weight of 203 lbs. with a body mass index of 29.2. Forty-

eight of the patients had osteoarthritis. Each patient was the first

surgical case of the day.

Berger, who pioneered and perfected minimally invasive outpatient

surgery, explains his technique for total knee arthroscopy (TKA) does

not cut the quadriceps muscle and quadriceps tendon.

" The only incision is from the joint line to the superior pole of the

patella. The quadriceps tendon is not cut or split. The knee is not

dislocated; instead, in situ cuts are made. The patient is out of

surgery in less than two hours. "

After surgery, patients see an occupational and physical therapist.

To be released, patients must be able to independently get in and out

of bed, rise from a chair, walk 100 feet, and walk up and down a full

flight of stairs. Patients are then asked if they feel comfortable

and would like to go home and are released with pain medication.

Patients receive home physical therapy until they can drive; then,

outpatient physical therapy is started. Patients were evaluated

clinically and radiographically in the office at one week, two weeks,

six weeks, and three months.

Berger says this study demonstrates that, in these selected patients,

" outpatient TKA was safe with no short-term readmission or

complications related to early discharge. New clinical pathways,

including improvements in anesthetic techniques, postoperative pain

management, and rehabilitation protocols, will make performing

outpatient TKA a realistic goal. This comprehensive pathway may make

it possible for this minimally invasive knee surgery to be done as an

outpatient in specialized surgicenters in the future. "





More information:

www.rush.edu