Amid advances in robotic technology for Total Knee Replacement (TKR) procedures, patients’ needs extend beyond accurate and minimally painful surgery to include a comfortable and rapid recovery process.
This is where Enhanced Recovery After Surgery (ERAS®) comes in. It is a globally recognised multidisciplinary approach designed to optimise care from the pre-operative stage through to recovery. It aims to reduce post-operative stress, optimise care, accelerate the recovery process and improve overall clinical outcomes.
In Indonesia, the ERAS® protocol has been implemented by Mayapada Hospital Surabaya (MHSB) and Mayapada Hospital Jakarta Selatan (MHJS) for robotic TKR procedures using the VELYS™ Robotic-Assisted Solution.
This approach supports faster recovery, optimal knee function, patient satisfaction and consistent clinical outcomes. The ERAS® protocol is implemented through collaboration among a multidisciplinary team comprising orthopaedic surgeons, anaesthetists, rehabilitation medicine specialists, nurses, nutritionists and physiotherapists.
The ERAS® protocol is implemented across three phases: pre-operative (Optimisation), operative (Execution) and post-operative (Recovery).
Prof. Dr. dr. Dwikora Novembri Utomo, Sp.OT(K), Chair of the Orthopaedic Board at Mayapada Healthcare, explained, “During the pre-operative phase, the implementation of ERAS begins with pre-admission optimisation through patient and family education, as well as an assessment of health conditions such as nutritional status, anaemia, diabetes, heart function and comorbidities. Patients are also advised to stop smoking and consuming alcohol, and undergo prehabilitation involving muscle-strengthening, mobility and walking exercises. They are also required to fast using the 6-4-2 method, which involves stopping solid food six hours before surgery, consuming clear fluids up to four hours before surgery, and drinking carbohydrate-rich beverages two hours before surgery.”
During the operation, the procedure is performed according to measurable standards and techniques designed to minimise tissue trauma, allowing the surgery to be completed in less than 90 minutes.
“The procedure is performed using VELYS™ robotic technology to support the accurate placement of joint implants, soft-tissue balancing and a more controlled surgical process, thereby supporting faster recovery. The surgery is also performed without inserting a drain for residual surgical fluid or a urinary catheter, while a more optimal wound-closure technique is used to reduce the risk of infection,” Prof. Dwikora explained.
At this stage, the role of the anaesthetist is crucial in ensuring that patients undergo surgery safely.
Dr Agus Setiyana, Sp.An., KAKV., FIPM., FIPP, from Mayapada Hospital Surabaya, explained, “The ERAS protocol prioritises the use of regional anaesthesia for the surgical area, supported by various pain-management methods. During surgery, patients are also given medication to reduce blood loss and prevent nausea and vomiting, while ensuring that their fluid requirements and body temperature remain optimal.”
He continued, “After surgery, patients can begin eating and drinking earlier to accelerate the recovery process. With optimal pain management, patients can begin moving and walking without pain after surgery. With the ERAS protocol, patients can require a hospital stay of only one night,” said Dr Agus.
During the recovery phase, patients undergo a gradual early-mobilisation programme.
Dr Yohan Christian Suisan, Sp.KFR., M.Ked.Klin., AIFO-K, from Mayapada Hospital Surabaya, explained, “The ERAS protocol is designed in such a way that patients are able to walk on the same day (same-day mobilisation). Rehabilitation continues with exercises to restore knee strength and function. Patients are only allowed to go home once their pain is under control, they are able to walk safely and they are ready to continue their exercises at home.”
The implementation of the ERAS protocol at MHSB has been shown to improve clinical outcomes, following the success of the first robotic TKR procedure in East Java and Eastern Indonesia using VELYS™. The procedure reduced the average hospital stay from five days to 1.6 days, accelerated recovery by nearly 50 per cent and reduced complications by up to 60 per cent.
This achievement also made MHSB the only hospital in Indonesia to receive ERAS® certification for robotic TKR procedures, as well as becoming a member of the ERAS® Society, a global organisation that develops evidence-based standards for post-operative recovery.
Meanwhile, the ERAS protocol has also been implemented at Mayapada Hospital Jakarta Selatan (MHJS) for robotic TKR procedures led by Dr Immanuel Panca S. Sitorus, Sp.OT(K) Hip & Knee, together with Dr Yulia Hafni, Sp.An, and Dr Jovita Maria Melania Setiawan, Sp.KFR. The specialists actively collaborate to optimise patient recovery.
People no longer need to travel overseas to receive advanced TKR treatment, as these services are now available in Indonesia through the Orthopaedic Centre at MHSB and MHJS.
If you begin experiencing knee pain, consult a doctor at the Mayapada Hospital Orthopaedic Centre through the Call Centre at 150770, WhatsApp at 0817-17-150770, or the MyCare app. For emergency cases, contact the Emergency Call service at 150990.
Information about bone and joint services at Mayapada Hospital is also available through the Health Tips & Articles feature on MyCare, as well as the Personal Health feature, which can be used to track daily steps, calories burned, heart rate and Body Mass Index (BMI).