Day case knee replacement surgery: An innovative approach

Knee pain can be debilitating, affecting our mobility and quality of life. For those who have exhausted non-surgical treatments, knee replacement surgery can offer a new lease on life. But did you know that modern medicine has made it possible for some patients to undergo knee replacement as a day case procedure? In this article, renowned consultant orthopaedic surgeon Mr Manju Ramappa explores the ins and outs of day case knee replacement surgery, answering some common questions about this innovative approach.

When might someone need a knee replacement?

Knee replacement surgery is typically considered when conservative treatments like medications, physical therapy, and lifestyle modifications no longer provide sufficient relief. Individuals suffering from severe arthritis, injury-related joint damage, or chronic knee pain that significantly hampers their daily activities may be candidates for knee replacement.

Can a knee replacement be done as a day case?

Yes, day case knee replacement surgery is a viable option for most patients. It's a novel approach that allows patients to mobilise on the day of surgery and also to return home on the same day as their surgery. If at any point we felt that the patient was not safe for discharge, we would keep them in the hospital overnight.  Day case surgery aims to mobilise patients as soon as possible. They may or may not go home on the same day of surgery as this depends on several factors such as their mobility before surgery, pre-existing serious health issues, and the time of the day they have surgery.

What does the surgery entail?

Day case knee replacement surgery is a highly specialised procedure. I have designed the protocol for this based on the latest evidence. Patients undergo pre-surgery optimisation, aggressive pain management post-surgery and early mobilisation. During the surgery, the damaged or diseased portions of the knee joint are removed and replaced with an artificial joint made of metal and plastic components. This artificial joint, known as a prosthesis, is designed to mimic the natural movement and function of a healthy knee.

The surgery can be performed under either spinal anaesthesia or general anaesthesia. Spinal anaesthesia tends to be more comfortable for patients post-surgery, as they do not get the after-effects of general anaesthesia. The patient remains comfortable and pain-free throughout the procedure. I use a meticulous approach, reducing tissue trauma and promoting a quicker recovery. After the surgery, patients are carefully monitored for a few hours before they are allowed to go home.

How long does It take to recover from a day case knee replacement procedure?

One of the main advantages of day case knee replacement surgery is the faster recovery compared to traditional inpatient procedures. While the exact timeline can vary from person to person, most patients can expect to resume their normal activities within days to weeks after the surgery.

Physical therapy plays a crucial role in the recovery process. Patients will work with a physical therapist to regain strength, flexibility, and range of motion in the knee. Full recovery can take between 2 to 3 months, depending on individual factors and adherence to the recommended rehabilitation program.

What are the advantages of day case knee replacement?

The main advantages are related to early mobilisation such as lowering the risk of clots and hospital-acquired infection. In my experience, it also improves patient motivation which is extremely important for post-op recovery. When patients mobilise early, they actually experience less pain interestingly.

I want all my patients to

• Have excellent pain relief
• Mobilise early
• Recover quickly

What is your experience with day case knee replacement?

I am one of the first few surgeons in the UK to pioneer this technique. I have successfully set up a day case pathway at Nuffield Tees Private Hospital and also at North Tees & Hartlepool NHS Foundation Trust. I have utilised the latest evidence and techniques while designing this pathway. I started doing day case knee replacements at Hartlepool NHS Trust in December 2021 and at Nuffield Tees Hospital in June 2023.

Below is a picture from the first day case knee replacement procedure at Nuffield Tees Hospital. He was the first patient at Nuffield Tees to have day case knee replacement, hence the celebrity status! He did exceptionally well.

If you would like to book a consultation with Mr Manju Ramappa, you can do so today via his Top Doctors profile.