According to findings from a new US study into recovery from joint replacement surgery, there is no heightened risk to patients if their stay in hospital is shortened and they are encouraged to go home and take a more active role in their own rehabilitation.
The findings, explained by surgeon Michael P. Ast of the Hospital for Special Surgery in New York, suggest that “there is a massive shift taking place toward more ambulatory hip and knee replacement surgeries that allow that patients go home on the same day of their operations.” This follows a growing trend across many areas of medical practice, whereby care is encouraged outside of the primary medical setting.
There are many factors which affect the shift towards same-day hip replacement. Over the years, medical processes have improved significantly. Hip replacement operations have been undertaken for decades, so surgeons have the benefit of many, many years of medical data to help improve practices. The design and materials used for the implant materials have also evolved and improved, plus we know more now about managing pain relief through a variety of different approaches.
This philosophy is reflected in the enhanced recovery programme that is run by the Fortius Clinic in London. The ethos at the Fortius Joint Replacement Centre (FJRC) at the BUPA Cromwell Hospital, is to encourage an Enhanced Recovery Pathway (ERP); there are many benefits to this approach accelerating patients’ recovery.
The ERP at Fortius is designed to give more control to patients to help steer their recovery and empower them to push themselves to full rehabilitation. The programme involves patients more collaboratively in the design of their recovery and encourages them to get a support network in place to help manage their rehabilitation. They are also encouraged to get out of bed at the earliest opportunity and begin testing the new joint. This is proven to help kick start the healing process – both mentally and physically – and is a big step forward compared with the previous recommendation of more prolonged bed rest following operations such as this.
What are the benefits of an ERP?
Typically, patients who follow the ERP approach can expect to stay in hospital for a shorter amount of time, at the moment typically around three days. As this report confirms, shorter length of stay can be achieved in suitable patients, with an appropriate home environment. The type of anaesthetic is important; we use largely spinal anaesthetic, which is proven to have many advantages over general anaesthetic. In addition pain control, including local anaesthetic techniques around the surgical wound, are very important in patients early recovery and we have well-established protocols to manage this.
Patients can enjoy a quicker recovery in the early days following their operation and can begin to see a greater range of motion and movement returning faster. Patients tend to find the recovery more comfortable as the medical support equipment is removed earlier – this includes apparatus such as bladder catheters, oxygen tubes and wound drains. These are all removed before the patient returns home, assuming the patient’s health and general state of recovery allow for this. The approach also tends to yield less post-operative complications.
A promising outlook for hip replacement patients
These findings are very encouraging for medical practitioners and patients. Although a quick discharge via an ERP won’t be suitable for everyone, for patients who are in a good state of general health, who have a support network to give assistance at home and who do not have any other underlying, serious medical conditions (such as heart disease, history of blood clots), this approach is proven to yield a faster and better recovery and can enable patients to get back to feeling normal and mobile much quicker.