In November 2018 doctors of Max Smart Super Speciality Hospital, Saket performed a minimally-invasive Total Knee Replacement (TKR) in one hour. This was India’s first Daycare TKR surgery and was performed on a Kenyan patient. Also, there was minimum exposure, blood loss and hospitalisation. This brought down expenses by 30%-35% along with reduced risk of infection. As part of rehabilitation, the patient was made to walk using a walker within six hours of the surgery. He was discharged earlier too, after a hospital stay of just 12 hours. The patient showed considerable improvement and was able to walk without support in 48 hours.
As this was the first daycare procedure, due care was taken by the hospital. For faster recovery, Max@Home provided medical expertise and quality care at the patient’s home for five days. There were intensive care nurses, doctor visits twice a day, visits by anaesthetists and physiotherapist for up to72 hours. Related equipments, doctors and ambulance were on standby. Arrangements were made for medications, crash cart with essential life-saving drugs and means to communicate any emergency were set up.
While it may not always be possible for most to afford such specialised and intensive post-operative care, it is certainly possible to follow a dedicated routine to regain health. This becomes even more crucial given the fact that with advancements in surgical procedures nowadays, the patient is discharged earlier. Hence, a significant part of the recovery process is to be shouldered by the patient. Even as the recovery depends on factors such as age of the patient, his health and other pre-existing conditions, complete recovery typically takes 12 weeks.
Soon after surgery, the patient is made to use his artificial knee using a crutch or any other assistive device under the guidance of a Physical Therapist (PT). The PT demonstrates the exact way to get in and out of bed and the right way to move with the aid of assistive devices. The patient has to follow the same instructions at home too.
A nurse or Occupational Therapist (OT) guides as regards changing the bandage, dressing, bathing and using the toilet.
After discussing the patient’s home environment, the PT sets up the patient with a continuous passive motion (CPM) machine for use in the hospital room and possibly at home. The machine keeps the knee in motion to prevent build-up of scar tissue and stiffness from immobility.
The patient continues to use the CPM machine. The patient is made to walk for brief periods and is encouraged to begin simple physical activities such as walking to the toilet or climbing a few steps. Physical activity is slightly enhanced as recovery begins to pick up pace.
This schedule continues for another 2 days, after which the patient is discharged. By now, the knee is also getting stronger and the patient is able to increase his activity levels. This is decided by the PT’s assessment of recovery. The patient is asked to go on longer walks, climb up flight of stairs and do other normal activities without assistance. At this point, the patient should be able to bend his knee, preferably to 90 degrees angle. Also he should be able to achieve a 90 degree range of motion so that he can alternate between sit and stand. Additionally, he should be able to dress and bathe on his own. The patient is then put on lower-dose pain medication as against prescription-strength painkillers.
Discharge through Week 3
In the period up to the third week, there is increased comfort in carrying out simple physical activities and reduction in pain. Resultantly, the doctor reduces the medications even as the patient may be asked to keep using a CPM machine during the period.
Weeks 4 to 6
During this period, the knee displays significant improvement with improved flexion (bending) and strength. Here, the patient is completely weaned off any assistive device. The patient notices increased independence in carrying out daily household chores. While, it may be too soon to resume work and any other strenuous activities, the knee is expected to achieve improved range of motion.
Weeks 7 through 11
During this period, the patient’s recovery is improving already and he is able to perform basic activities that require mild physical exertion such as driving, shopping and housekeeping. The PT monitors the exercises in this period and even modifies them as the knee improves and can be moved freely. By now, the motion is expected to have improved to 115 degrees. The knee and surrounding areas have gained increased strength. On the part of the patient, he ought to stick to his rehab and exercise regimen. This becomes even more crucial now as the long-term success of the surgery depends on dedicated adherence to the exercise regimen.
If the patient has been consistent in his practice of the recommended exercises, he is most likely to be indulging in activities such as walking, swimming, golf, dancing and bicycling. However, high impact activities such as running, aerobics, skiing, basketball, football and high-intensity cycling should be avoided at all costs. By now, the patient is almost free from any pain in the knee. There is no loss flexion or range of motion. The patient can engage in various physical activities that do not require as much physical exertion.
From here on, there is gradual and continuous improvement in the knee. However, it takes a year before the patient feels at or near 100%. While the patient ought to be in touch with his doctors, at no point should he slacken on his efforts except if he experiences pain or swelling. In which case, he must bring it to the notice of the medical team.
Thus, a patient’s recovery depends to a large extent on his adherence to the recommended exercises, even as doctors and surgeons are available to monitor the progress.