Authors (including presenting author) :
Yuen HY(1), AU OL(1), Ieong HI(1), Wong PW(1), Ng CK(1), Chow HY(1), Wong SW(1), Chiu CK(2)
Affiliation :
(1) Physiotherapy Department, United Christian Hospital, (2) Department of Orthopaedics and Traumatology, United Christian Hospital
Introduction :
Unicompartmental knee arthroplasty (UKA) is an effective procedure in managing osteoarthritic knee with early discharge. “Day Case” approach has also been adopted particularly during the COVID-19 pandemic. Incorporating the beauties of Enhanced Recovery After Surgery (ERAS), same-day discharge (SDD) after UKA becomes feasible, which reduces bed occupancy and eventually saves cost and alleviates the burden on public health care system.
Objectives :
This study aimed at identifying the roles of Physiotherapy and exploring the keys to success of SDD following UKA in a Hong Kong regional hospital.
Methodology :
A multi-disciplinary care model for SDD was established in United Christian Hospital (UCH) since Jul 2020. Physiotherapists provided Prehabiliation prior to UKA; also Pain Management and Mobilisation on Day of Surgery (DOS), Immediate post-discharge Telecare and Early Rehab in out-patient physiotherapy. Clinical information of 74 patients undergone UKA between Jan 2021 and Dec 2022 was collected for prospective data analysis.
Result & Outcome :
Among the 74 patients (N=74), 49 patients (66%) tolerated mobilisation on DOS; 23 cases (31%) were successfully discharged home on D0, and 33 cases (44.6%) were discharged on D1. The average LOS for this study group was 1.66 days. Main Obstacles of DOS mobilisation were “Not the first surgical case” (80%), “Healthcare Communication Gaps”(8%) ,“Unstable Medical Condition after Surgery” (4%) and “Post-operative Vomiting” (4%). The major reasons of delayed DOS discharge after mobilisation were “Post-operative Pain” (38.4%), "Unstable Medical-Condition "(26.9%), “Mobility Deficit” (11.5%), “Psychologically Unready” (7.7%) and “Excessive wound Oozing”(7.7%). Home exercise was prescribed via HA GO to all cases before hospital discharge. Telecare in form of phone or zoom consultation was delivered to ensure safe discharge and independent mobility after returning home. Fast tract out-patient physiotherapy for continuation of intensive rehab had also been arranged upon discharge. The care model demonstrated that DOS Discharge for UKA patient is safe and effective. Meticulous patient selection, prehabilitation for physical optimization and psychosocial preparation, operation scheduling, effective pain control, close collaboration with surgeon, intensive physiotherapy on D0, making use of telehealth contribute to the success.
