Dr Sumit Mahajan
Fast track program is a well-established approach for the patient undergoing selective operations. With the increasing life expectancy, there will be an increase in no of patients undergoing knee replacement surgeries.
During my experience, I have seen a decrease in the days of hospitalization in a joint replacement surgery from 7 days in 2010 to 3 days in 2020. Day is not far off, when it will be a day care procedure in India too. My western colleagues have already started with the same.
The program is multimodal and multidisciplinary; involving surgeons, anaesthesiologists, physiotherapist, nurses and even trained help. The principle is to increase patient satisfaction, confidence and lower hospital acquired morbidity. It consists of careful patient selection, preoperative care, minimizing perioperative stresses, decreasing post-operative discomfort.
It is the duty of the surgeon and his team to educate the patient and his family members to notify what will happen during their stay in the hospital and reduce their anxiety. It will target towards preventing the patients or their family members to hold unrealistic expectations. Post-operative availability of home physiotherapist or nursing care at home is also the smart way to increase the compliance of the patient towards fast track surgery.
Choice of anaesthesia holds an important role in a fast track knee replacement. We advocate spinal anaesthesia with LIA (local infiltration anaesthesia) in all my unilateral as well as bilateral knee replacement. LIA consists of cocktail of various drugs along with local anaesthesia.
Next important thing in FTK replacement is the duration of surgical procedure and minimum invasive (MI) procedure. Surgical duration should be minimized as short as possible. Prolonged operative time may be highly associated with increase rate of surgical site infection, deep wound infection etc. Minimal invasive approach allowed smaller wound incision, less soft tissue trauma, less invasion to muscle especially quadriceps.
Early ambulation and exercise are the indispensible part of the fast track program. It usually starts 6-8 hrs after surgery on day 0. It is important technique to prevent complications. It reduces the hospital stay and boosts patient’s confidence. We have also found decrease in usage of post- operative painkillers under this dynamic program.
(The author is Director Orthopaedics & Joint Replacement IVY Hospital, Amritsar)
Dr Sumit Mahajan