Achieving discharge within 24 hours of robotic unicompartmental knee arthroplasty may be possible with appropriate patient selection and a multi-disciplinary team approach

Abstract Aims There has been significant interest in day-case and rapid discharge pathways for unicompartmental knee replacements (UKR). Robotic-assisted surgery has the potential to improve surgical accuracy in UKR. However, to date there are no published studies reporting results of rapid-discharge pathways in patients receiving UKR using the NAVIO◊ robotic system. Methods A retrospective analysis identified 19 patients who were safely discharged within 24 hours following UKR using the NAVIO◊ robotic system between June 2017 and October 2019. All patients went through a standardised UKR pathway protocol. Pre-operatively patients underwent education sessions and anaesthetic assessment, with selected patients undergoing occupational / physiotherapy assessment prior to surgery. All patients received a general anaesthetic with local anaesthetic infiltration prior to closure; nerve blocks were not used routinely. A multi-modal analgesic regime was utilised. Patients were discharged home once they were safe to mobilise on ward, had normal vital signs and pain was adequately controlled. Patients were discharged with outpatient physiotherapy referral and consultant follow up at 6 weeks. Results All patients were discharged within 24 hours; there were no post-operative complications and no readmissions to hospital. The mean length of stay was 19.5 hours (SD=6.8), with patients seen twice on average by physiotherapy post-operatively. Active range of motion at 6 weeks was 105.8 o, with all patients mobilising independently. The median 6-month post-operative Oxford Knee Score was 44 out of 48. Conclusion This initial feasibility study suggests that patients may be safely discharged within 24 hours of UKR using the NAVIO robotic system. Appropriate patient selection will ensure successful discharge. Further prospective studies are needed.