Global Health Asia-Pacific May 2022 May 2022 - Page 46

SPONSORED FEATURE

DAYCARE TOTAL KNEE REPLACEMENT SURGERY

A Q & A with Dato ’ Dr Siva Kumar Ariaretnam , Consultant Orthopaedic Surgeon , Subang Jaya Medical Centre
Fastrack TKR basically gives the patient the ability to walk within a few hours of surgery and even climb stairs the same day .
Are you excited about being the 1st in Malaysia to do a daycare total knee replacement ? I have been doing fastrack total knee replacement ( TKR ) for about a decade now consistently , so daycare surgery is just a validation of a whole process of improving outcomes . TKRs have evolved ever since I started doing them , in ways that I would never have imagined and I ’ m happy to be a part of evolution .
What is fastrack knee replacement ? Fastrack TKR basically gives the patient the ability to walk within a few hours of surgery and even climb stairs the same day .
This also culminates in the ability to walk quicker and return to work and activity sooner after surgery . Daycare surgery simply means that in addition to this the patient is admitted and discharged the same day .
As I understand knee replacements are very painful and it often needs injections to control the pain of surgery . So how is pain controlled with fastrack TKR ? Yes , they are indeed painful procedures . The way I initially did them almost 20 years ago , the pain had to be controlled with various injections and the patient was on a knee immobiliser for 24 hours at least and made to walk ( with a lot of difficulty ) 1-3 days after surgery . The knee was bent and extended slowly on a continuous passive mobilisation machine known as a CPM . These days some patients operated on in the morning are able to walk by lunchtime and climb stairs by evening . They bend their knees as they are being wheeled out of the operating theatre . I do not remember using a CPM machine in the last 10 years .
So what had changed in your practice to allow you to do this ? A few things . The surgical approach . 90 % of surgeons around the world use a gold-standard muscle-splitting approach to the knee . This is what I used in the first 10 years as well . Now I use a muscle-sparing approach to the knee such that the muscles are retracted for the most part instead of cut to do the surgery . This greatly reduces the pain and allows rapid recovery and return to function after surgery .
I have developed a novel wound-closure technique
44 MAY 2022 GlobalHealthAsiaPacific . com