Authors (including presenting author) :
Chang WYE, Chow ML, Ng WY, Chung WTE, Lee QJ, Wong YC
Affiliation :
Department of Orthopaedics & Traumatology Yan Chai Hospital
Introduction :
One-stage bilateral total knee replacement (BTKR) is one of the options for patients with moderate to severe arthritis of both knees. It has the advantages of a single hospital stay, shorter rehabilitation, and reduced administrative cost. However, there may be risks of a higher complication rate. A well-constructed protocol in one-stage BTKR is therefore designed to provide a safe and cost-effective outcome.
Objectives :
To improve patient outcome To provide cost-effective care
Methodology :
A multi-disciplinary approach protocol was designed which was comprised of pre-operative assessment of comorbidity and patient selection, nurse clinic education, assessment and monitoring, blood management, advanced surgical technique, intra-operative local infiltration analgesia, multimodal pain management, fast-track physiotherapy, early discharge planning and home modification before admission.
Result & Outcome :
Result From 2011 to 2018, 283 patients received BTKR(10% of total knee replacement). The average total length of hospital stay for two knees was shortened from 14.5 to 5.8days. 88.5% of the patients were directly discharged home. There was no significant difference in the readmission rate and complication rate compared with sequential TKR. 95% of the patients were satisfied with the procedure. The estimated cost saved was $48506 per patient. Conclusions This study shows that the multi-disciplinary approach protocol for BTKR is cost-effective and can improve patient outcome.
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