Authors (including presenting author) :
Yuen HY(1), AU OL(1), Wong PW(1), Ng CK(1), Chow HY(1), Wong SW(1), Lam KW(2), Chiu CK(2), Cheng HC(2)
Affiliation :
(1) Physiotherapy Department, United Christian Hospital, (2) Department of Orthopaedics and Traumatology, United Christian Hospital
Introduction :
Unicompartmental knee arthroplasty (UKA) has been successfully performed in both United States and United Kingdom healthcare systems. Despite differences in the healthcare structure and funding, it would be feasible to replicate this success and perform UKA with safe Day of Surgery (D0) discharge in a local regional hospital under Hospital Authority in HONG KONG.
Objectives :
1.To explore the keys to success of discharging patients on Day of Surgery following UKA 2.To identify the roles of Physiotherapy in UKA for facilitation of safe discharge
Methodology :
A pilot multi-disciplinary clinical pathway was established in United Christian Hospital (UCH) since Jul 2020 and December 2020 aimed at discharge on Day of surgery (DOS) after receiving UKA. Physiotherapist being the only rehab specialist in the team provided the followings in various phases: 1.“Prehabiliation” covering both physical training and support for discharge home before the UKA 2.“Pain Management” and “Early Mobilization” right after recovering from the surgery on D0 onwards 3.“Tele Care” immediate after discharge and 4.“Fast Tract Rehab” in physiotherapy out-patient clinic shortly after home Clinical Data was collected prospectively for analysis.
Result & Outcome :
16 patients were recruited in the study. Physiotherapists successfully mobilized 14 patients (88%) straight away after the surgery. 4 cases (25%) were facilitated home on D0 and the remaining 8 cases (50%) were discharged on D1. None readmission was reported. The average length of stay for this study group was 1.44. Leading causes for deferring the discharge to D1 were medical conditions, wound oozing, leg pain and weakness. Psychologically unready for D0 discharge was also reported. All cases received physiotherapy on next working day immediate after hospital discharge. On need basis, the care could be in form of phone consultation or together with surgeon through tele consultation in specialist out-patient clinic. Admission as day case for intensive physiotherapy was also an option. Early physiotherapy appointment usually within a week was offered to this group of patients. Conclusion: D0 discharge for patients with UKA is feasible in UCH. Meticulous patient screening, Prehabilitation, effective pain control, early mobilization and timely post discharge care are key factors for successful early and safe discharge.
