Hip replacement and home in three days

Patients at NNUH are among the first in the region to benefit from a team approach to post-operative care that allows them to be up and walking within hours of a knee or hip replacement.

New techniques in pain relief, coupled with early intervention from physiotherapists and occupational therapists, are helping to get them back on their feet and home within four days of their surgery.

“Until I saw it for myself I would never have believed it possible for patients to recover so quickly after their surgery,” says orthopaedic surgeon Mr James Wimhurst. “We decided to run a pilot project at NNUH and the results from a study of the first 30 patients have been very impressive.

“It seems that targeted pain relief, plus early intervention from physiotherapists and occupational therapists, can have a very positive impact on patients, both physically and mentally.”

The new techniques involve an injection of local anaesthetic straight into the joint by the surgeon, followed by an infusion of anaesthetic into the joint and a combination of painkillers taken orally. There is no need for urinary catheters or drains and the patients are able to get mobile much more quickly, reducing the risk of complications such as blood clots and chest infections.

Consultant anaesthetist Dr Lindsay Barker, who has been leading the project, says a series of small changes, rather than one big change, have made the difference for patients. “Having everyone pulling in the same direction is vital,” she said. “We have a great team of nurses, physiotherapists, occupational therapists and pharmacists who have helped to bring about this huge improvement.”

Sixty-six-year-old Annie Bennett, from Postwick near Norwich, a retired family therapist, was delighted to be walking around the ward less than ten hours after undergoing a hip replacement.

“Psyschologically it was a great boost to be able to get on my feet so soon after my op. I’ve had fantastic care and I can’t wait to get back to walking and swimming after years of feeling old before my time.”

Denton ward sister Kay Marrison commented: “With this new technique patients are far less dependent and anxious and it’s very clear that ‘mind over matter’ plays a very big part in their recovery.”

• At NNUH, orthopaedic surgeons Jim Wimhurst, Nish Chirodian and Keith Tucker introduced a modified version of the procedure at NNUH after a visit to Glasgow earlier this year.

• Previously, patients had an epidural injection in the back which meant they were numb from the waist down and confined to bed for 24-48 hours after a hip or knee replacement.

• The average length of stay at NNUH for a traditional hip replacement was 7.5 days, compared to 3.6 days for the first 30 patients in the pilot project.

• Of the first 30 patients surveyed, 100 per cent agreed that their pain had been well managed and 93 per cent were happy with the speed of their recovery.

• The ‘enhanced recovery’ programme at NNUH is currently limited to hip and knee replacements but could potentially be extended to shoulder surgery. The colorectal surgeons at the NNUH are also piloting an enhanced recovery project which enables patients who have had major bowel surgery to go home earlier.

The new ‘enhanced recovery’ technique has been used in Scandinavia and Australia for seven to ten years and more recently at the Golden Jubilee National Hospital in Glasgow.