When does recovery start?
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A different way of thinking about recovery
Traditionally, success in a total knee replacement was measured by what happened in the operating theatre. Was the implant positioned correctly? Were there complications? Did the procedure go according to plan? Those questions remain important. But they only tell part of the story.
Over the past decade, clinicians began looking beyond the operation itself and examining the entire patient journey, from preparation before surgery to recovery after discharge.
The rationale was simple: recovery is shaped not by a single intervention, but by a series of decisions made before, during and after surgery.
“Earlier discharge was not driven by one intervention alone. It came from cumulative improvements across the entire care journey, from identifying and optimising patients before surgery to better surgical, anaesthetic and rehabilitation practices.”
– Adj Asst Prof Amritpal Singh
Recovery begins before surgery
One of the earliest lessons was that preparation matters. Before surgery, patients are assessed and optimised through measures such as managing pre-existing medical conditions, identifying anaemia early, improving nutrition and preparing them for recovery.
According to Adj Asst Prof Amritpal Singh, Head of Division & Senior Consultant, Division of Hip & Knee Surgery, Department of Orthopaedic Surgery, Ng Teng Fong General Hospital (NTFGH) and Senior Consultant, Division of Hip & Knee Surgery, Department of Orthopaedic Surgery, National University Hospital (NUH), patients who enter surgery better prepared often recover more smoothly afterwards. A patient with optimised haemoglobin levels is less likely to require a blood transfusion and may have more physiological reserve for recovery. When combined with effective surgical care and rehabilitation, the impact can be significant.
Recovery starts with movement
Pain is often one of the biggest barriers to recovery.
In the past, many patients were reluctant to move because of post-operative discomfort. Today, multimodal pain management, improved surgical techniques and targeted pain control help patients sit up, stand and begin walking much earlier than before.
Earlier mobilisation plays an important role in recovery. It allows patients to participate more actively in rehabilitation and reduces complications associated with prolonged bed rest.
What changed?Prehabilitation, anaemia optimisation, multimodal pain management and enhanced recovery pathways helped patients start moving sooner and recover faster.
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But the goal was never simply earlier discharge. The goal was better recovery.
Patients regain confidence sooner because they are moving earlier, experiencing fewer setbacks and returning more quickly to their normal routines.
For families and caregivers, shorter hospital stays can also mean less disruption and an earlier return to everyday life.
“For patients, earlier discharge means returning more quickly to the comfort and familiarity of home.”
– Adj Asst Prof Amritpal Singh
Doing what works
One of the biggest changes brought about by Value-Driven Outcomes was the ability to move beyond assumptions and examine which interventions genuinely made a difference.
Rather than doing more, teams focused on doing what worked. Data helped clinicians continually refine care pathways, identify unnecessary practices and focus resources on interventions that delivered the greatest impact on recovery.
“Value-based care is not about adding more interventions. It is about identifying which interventions make the greatest difference and applying them at the right time.”
– Adj Asst Prof Amritpal Singh
“The real success isn't that patients leave hospital earlier. The best outcomes are that they recover sooner, regain their independence faster, and return to the activities that matter most to them.”
– Adj Asst Prof Amritpal Singh
The biggest advances in total knee replacement care did not come from changing one operation.
They emerged from rethinking the entire journey. By measuring what mattered, clinicians discovered that some of the most important moments in recovery happen long before patients enter the operating theatre.
Appropriate and Value-Based CareAppropriate and Value-Based Care (AVBC) starts with a simple question: what outcomes matter most to patients? By measuring outcomes and learning from variation, clinicians can identify what works, redesign care pathways and continually improve care. The goal is not simply to do more, or spend less. It is to deliver better outcomes for patients while making the best use of healthcare resources. |
In consultation with Adj Asst Prof Amritpal Singh, Head of Division & Senior Consultant, Division of Hip & Knee Surgery, Department of Orthopaedic Surgery, NTFGH and Senior Consultant, Division of Hip & Knee Surgery, Department of Orthopaedic Surgery, NUH.
