Enhanced Recovery (ERAS) Total Knee Replacement

Potentially shorten your hospitalisation stay for total knee replacement surgeries, making them a day surgery. Through Alps Orthopaedic Centre’s specialised Enhanced Recovery After Surgery approach, most patients experience fast recovery, less pain and a smaller bill.

When individuals experience severe knee pain that significantly compromises their quality of life and disrupts sleep, orthopaedic surgeons may recommend total knee replacement surgery. Those who require this surgery typically struggle with:

• Pain
• Stiffness
• Walking long distances
• Climbing stairs
• Rising from chairs 
• Swelling 
• Weakness 
• Squatting

When non-surgical treatments like medication, physical therapy, and lifestyle modifications no longer effectively manage knee pain or mobility issues, total knee replacement may be considered as an option.

While knee pain can stem from traumatic injury, arthritis remains the primary reason for undergoing total knee replacement surgery. Arthritic pain typically develops gradually over time because of the wear and tear of the knee joint, often becoming more apparent in older individuals. On the other hand, younger patients are more likely to experience knee pain as a result of sudden injuries,  such as those sustained during trauma episodes or sports activities.

^{What is Total Knee Replacement?}

Firstly, to understand total knee replacement, it is essential to grasp the structure of the knee. The knee is a large, weighbearing joint. In a healthy joint, cartilage cushions the ends of the bones, facilitating smooth and painless movement. 

However, individuals suffering from arthritis often undergo a breakdown of cartilage in their knees, resulting in bones rubbing against each other. Over time, this can lead to a narrowing of the joint space and the development of bone spurs or deformities. In severe cases, orthopaedic surgeons may recommend surgical procedures to replace damaged joint parts, either partially (partial knee replacement) or completely (total knee replacement). Usually, patients in the late stages of arthritis will be recommended to undergo total knee replacement, during which surgeons remove the entire knee joint and replace it with implants.

While total knee replacement has an initial recovery period spanning several weeks to months, opting for this procedure can significantly alleviate pain symptoms and enhance the patient's quality of life. Fortunately, some surgeons specialise in an approach called Enhanced Recovery After Surgery (ERAS) for this procedure. Besides employing a specialised surgical technique to minimise physical trauma, orthopaedic specialists also leverage other methods to provide patients with holistic care that potentially speeds up recovery.

How is the Enhanced Recovery After Surgery (ERAS) approach different from traditional Total Knee Replacement?

Unlike traditional surgeries, the enhanced recovery after surgery (ERAS) approach is an evidence-based and multidisciplinary perioperative care pathway that aims to reduce surgical stress and promote rapid recovery for patients. The ERAS approach involves three main parts: before, during, and after surgery. 

It starts with getting the patient in great shape before the operation. To assist in this process, orthopaedic surgeons can help by providing information and guidance beforehand.

Some of the key steps involved prior to surgery include:

• Counselling before surgery ensures that an individual is ready for the procedure. This may involve various assessments such as lab tests, x-rays, and even financial counselling
• Stop smoking and alcohol use four weeks ahead of surgery
• Check and treat anaemia if present
• Get nutritional advice and checkups; eat foods rich in carbohydrates
• Stick to clear fluid intake (e.g. water, apple juice, clear tea, black coffee) until 2 hours before surgery, with a 6-hour fast for solid food

Subsequently, in an ERAS approach, surgeons also employ minimally invasive surgical techniques during the operation for less tissue damage, reduced pain, and quicker recovery relative to traditional surgery. Consequently, it effectively reduces post-surgical discomfort and pain. After the surgery, a multifaceted postoperative programme will then be implemented to facilitate patient recovery.

How is the ERAS Total Knee Replacement surgery done?

Specifically, our orthopaedic surgeon will utilise the kinematic-alignment technique to restore the patient’s natural knee anatomy, minimising soft tissue damage and optimising joint mechanics. 

1. An incision will be made to the knee

During the surgery, he will create an incision about 10cm to 15 cm down the front of the knee instead of the 15cm to 25cm incision usually made during a traditional Total Knee Replacement surgery. The ERAS kinematic-alignment surgical technique is less invasive than Total Knee Replacement surgery. Hence, it typically results in a smaller scar, less pain, and less tissue disturbance compared to conventional Total Knee Replacement. 

2. The damaged parts will be replaced with a new joint

After the incision, the kneecap will be gently moved aside to access the knee joint with minimal disruption to surrounding tissues. The damaged ends of the shin bone and thigh bone are carefully removed, and replacement parts made of metal alloys and plastic are inserted over the bones to create the new joint. 

3. The surgical wound will be closed

After repositioning the kneecap, the surgeon closes the incision using stitches and then applies a dressing and bandage over it.

What does the postoperative care for ERAS Total Knee Replacement involve? 

After an ERAS total knee replacement, our experienced Orthopaedic team will carry out postoperative care. 

Immediately after surgery, care may include nurses monitoring the patient's vital signs (blood pressure, heart rate, respiration rate, temperature, and pain level), administering food/fluids through IV, and providing bowel care as necessary.

Afterwards, other important ERAS protocols will be followed, including active mobilisation (encouraging patients to start moving and engaging in physical therapy soon after surgery), early feeding with a high-protein diet, prevention of blood clots, and multimodal pain management, to speed up recovery and minimise complications beyond traditional care.

What is recovery like after an ERAS Total Knee Replacement?