Authors (including presenting author) :
Ko TS, Tse SH, Choi ST, Kwok TK, Wong KK
Affiliation :
Department of Orthopaedics and Traumatology, Kwong Wah Hospital
Keyword 1: :
Osteoarthritis of Knee
Keyword 2: :
Knee Replacement
Keyword 3: :
Unicompartmental Knee Replacement
Keyword 4: :
Ambulatory service
Introduction :
Knee replacement surgery for osteoarthritis (OA knee) has been one of the commonest operations performed in the field of orthopaedic surgery. While promising outcome is seen after the surgery, surging demand and the accompanied burden of hospital resources have been an established problem to solve for hospital authority. Unicompartmental knee replacement (UKR), which is characterized with minimal invasive technique, preserved knee kinematic, faster recovery, and better functional outcome, is an alternative surgical option other than the conventional total knee replacement (TKR) for selected patients. In late 2025, our department has developed a pilot ambulatory program, UKA Focusing Arthroplasty Same-day Discharge Track (UltraFAST), in hope of reducing bed occupancy and inpatient rehabilitation workload, without sacrificing patient's satisfaction and clinical outcome. Patients in the TKR waiting list who met the UKR selection criteria were offered with the option of UKR. Patients would be enrolled into UltraFAST program based on their age, comorbidities, family support, and willingness, while others would be admitted for conventional inpatient UKR. Patients in UltraFAST program would receive education on day surgery, streamlined postoperative mobilization and discharge workflow. The whole day surgery program would be carried out in ambulatory centre and operation theatre entirely. Patients who could not achieve same day discharge would be transferred to orthopaedics ward for inpatient care.
Objectives :
By selecting appropriate patients in TKR waiting list for UKR surgery, and recruiting them into ambulatory UKR program, we aim to; 1) Reduce bed occupancy; 2) Reduce demand of inpatient rehabilitation service; 3) Reduce hospital associated complications; 4) Maintain surgical outcome and patient's satisfaction.
Methodology :
Patients who underwent knee replacement from 10/2025 to 1/2026 by the same team of doctors were classified into UltraFAST UKR group, inpatient UKR group, and inpatient TKR group according to the type of their operation and admission. Clinical records were reviewed. Study outcomes included average length of hospital stay, number of sessions of inpatient physiotherapy, postoperative satisfaction score, improvement in range of movement and Knee Society Knee Score. We also conducted preoperative survey for Brief Resilience Scale (BRS), Risk Assessment and Prediction Tool (RAPT), and Pain Self-Efficacy Questionnaire – Abbreviated Two-Item Form (PSEQ-2) among the UltraFAST UKR group patients, and analysed the correlation between these scores and the failure of same day discharge.
Result & Outcome :
From 10/2025 to 1/2026, 7, 8, and 15 patients were classified into UltraFAST UKR group, inpatient UKR group, and inpatient TKR group respectively. The UltraFAST UKR group had the shortest length of hospital stay and least number of inpatient physiotherapy session. All three groups showed similar improvement in range of movement and Knee Society Knee Score in short term follow up. The patients in the UltraFAST UKR group who failed same day discharge and required ward admission had lower score in BRS, RAPT, and PSEQ-2. Being a pioneer ambulatory program, the UltraFAST UKR program demonstrated early success in reducing bed occupancy and inpatient rehabilitation workload in order to handle surging demand of knee replacement. BRS, RAPT, and PSEQ-2 may be used to identify the patients who are not suitable for ambulatory UKR service.
