Day case Total Hip Replacement

Day case total hip replacement is a recent milestone in the journey of Enhanced Recovery total hip replacement.

What is Enhanced Recovery Programme?

Enhanced recovery programme is the result of the constant strive to improve patient satisfaction, improve function, early recovery and minimise complications. This is constantly evolving. Innovation and evolution in all aspects of patient care mentioned below have led to the success we witness today. It is a multidisciplinary approach, and the main components are:

  1. Patient selection, education, and preparation
  2. Anaesthesia and pain management
  3. Minimally invasive surgery
  4. Post-operative rehabilitation

Patient selection, education and preparation is key. Evidence-based information and reassurance are given which improves patient confidence and raises expectation (however this could be different for each patient). Pre-operative assessment and pre-habilitation (exercises before surgery) prepares patients both mentally and physically; doing exercise before surgery helps patients to recover better.

Anaesthesia and pain management is crucial for performing surgery safely. Early recovery from anaesthesia influences how quickly patients start mobilisation. Early mobilisation certainly reduces risks like vasovagal attacks (drop in blood pressure when getting off the bed) and, on average, patients seem to be in less pain.

Minimally invasive surgery helps to minimise blood loss and patients tend to experience less pain. Preserving muscle function helps early and better recovery of hip function. Restoring the patient’s hip anatomy, good fixation of the prosthesis and using prostheses with excellent long-term track records are all crucial in achieving first-rate early and enduring results.

Post-operative rehabilitation starts with the help of physiotherapists and staff as soon as the anaesthetic effects wear off. It is known that the sooner patients start mobilising after surgery, the lesser the pain level experienced. This also expedites patient recovery and some studies have shown better patient satisfaction. Additionally, early mobilisation reduces the chance of clot formation in the leg veins. Once patients reach the expected mobility status and are medically stable, they will be discharged. Post-operative information keeps patients well informed, reassures patients and reduces anxiety.

The following is a short video clip of one of Mr Velayudham’s patient mobilising comfortably without support 12 days after surgery. The rate at which recovery takes place varies from patient to patient.

What is Day case total hip replacement

Day case hip replacement is where a patient is able to go back home safely on the same day after total hip replacement with the help of the enhanced recovery programme. A small group of patients will be eligible and generally these are patients with good fitness levels before surgery, no major medical problems and good social support. They will be able to safely go home on the same day as surgery and sleep comfortably in their own bed at home; it is a significant milestone in the enhanced recovery programme journey. Again, patient selection and education, good anaesthetic technique and pain relief, minimally invasive surgery together with a multidisciplinary approach to postoperative care are key.

Some patients might not be able to go home on the same day but will be able to go home within 24 hours to 36 hours after surgery. Common reasons for a slightly longer hospital stay are a delay in recovery from anaesthetic effects, post-operative problems like bladder retention and medical problems such as a drop in blood pressure. There is some evidence that this approach, achieving early mobilisation and recovery, has long-lasting effects on patient satisfaction.

The following is a short video clip of one of Mr Velayudham’s patients mobilising comfortably without support and ready to go home only a few hours after surgery. How quickly one can come off support safely varies from patient to patient. It is advisable to use walking aids for three to four weeks to protect the hip prosthesis, maximise bonding with the femur and acetabulum, and help muscles recover their strength to provide balance and stability.  Also, it is very important to prevent any falls in the early days.

Am I eligible for Day Case Total hip replacement

All patients who meet the criteria are eligible for day case hip replacement in hospitals where the programme is established. Not all patients will be eligible for day case total hip replacement. For example, a patient’s medical condition such as Diabetes Melliteus, major heart and lung problems, and complexity of their procedure might preclude them from having shorter acting anaesthesia, minimally invasive surgery, or early mobilisation. Their social situation might be such that a patient is unable to go home even though they are medically safe to leave the hospital. However, it has been shown that even in those patients, the ripple effect of applying the principles of the enhanced recovery programme helps them recover early and they have better satisfaction, shorter length of hospital stay and fewer complications.