Day case total hip replacement is a reality
- 15 May 2023
- Posted by: invicta_ortho
- Category: Hip
Day case total hip replacement is a classic example of improvements to patient care that can be achieved by multi-disciplinary teamwork. This includes our nursing staff, physiotherapists, occupational therapists, anaesthetist and surgeon. Patients are prepared (Patient selection and preoperative preparation) by providing them with clear and concise information regarding pre-operative preparation, anaesthesia, minimally invasive surgery as well as recovery timeframes and symptom control. The comprehensive pre-operative assessment also confirms patient suitability for a day case hip replacement. This improves patient confidence and helps to manage expectations.
An enhanced, safe and fine-tuned anaesthetic technique ensures that patients are pain-free both during and immediately after surgery. Recovery from anaesthesia is swift and allows patients to start mobilising quickly with our specialist physiotherapy team.
Minimally invasive total hip replacement preserves muscle function, minimises blood loss and reduces the risk of post-operative complications, such as haematoma formation. Restoration of optimal patient hip anatomy and secure implant fixation are vital. These anaesthetic and surgical approaches allow our patients to start mobilising early and safely under the guidance of specialist physiotherapy and nursing teams.
An individualised rehabilitation and recovery plan (Post operative management in the hospital) is carefully tailored for each patient by our ward team prior to discharge. This includes an exercise programme and layered-analgesia regime to instil confidence prior to same-day discharge. Patients are discharged if medically safe to go home and the patient feels confident to go home.
At discharge patients are provided with information on symptom management and control, and the use of our direct number for our specialist teams should any concerns or questions arise. In the unlikely event of complications these will be identified early and managed quickly (Post discharge management). This improves patient confidence, helps to detect any complications early and intervene appropriately.
It should be emphasised that daycase total hip replacement is not appropriate for everyone and, in fact, only a relatively small proportion of patients are eligible. Even some cases initially planned as day case surgery may not always be possible. For example, patients recovering from the effects of anaesthesia, mild complications like urinary retention and occasionally for social reasons. Some patients might not be eligible because of the complexity of the hip replacement, their underlying medical problems, physical fitness and social setup. It has, however, been shown that applying the principles of an enhanced recovery programme overall improves patient satisfaction and reduces the average length of stay in the hospital.
Twenty years ago it was not uncommon to spend ten days in hospital after hip replacement surgery. We have reduced this to 1–2 days for the majority of our patients at MTW, putting us in the top 2% of the United Kingdom. We are proud to have developed this further and to be able to offer many of our patients day case total hip replacement.
In the future it might be possible to progress this even further with total hip replacement mimicking some hand surgery procedures, where patients are discharged home from the recovery unit rather than needing admission. It is certainly an exciting time to be a hip specialist helping patients.
(Video picture of a patient of Mr Velayudham after minimally invasive total hip replacement mobilising unaided within a few hours of recovery from the anaesthesia and confirmed medically fit to be discharged. Please note, the recovery after hip replacement varies from patient to patient for various reasons.)
Although a proportion of patients can walk unaided very shortly after a total hip replacement all the patients are advised to use a walking aid in the first four weeks to allow time to recover from the effects of a major operation. Muscles need to regain strength and get used to the artificial prosthesis. Additionally, patients need time to adjust to the changes of position and movement (proprioception) from the joint and allow time for the bone to bond with the prosthesis well enough to take repetitive stress for many many years (hopefully decades) to come.
Mr Senthil Kumar Velayudham
MBBS, MS, FRCS (Tr & Orth)