Day Surgery Joint Replacement
Dr. Nizam has been performing joint replacements – bikini anterior hip replacements and patient specific (3D printed) Instrumented knee replacements for many years, where patients who are operated in the morning hours, who are medically fit and stable and mobilizing a few hours after surgery are certainly able to safely go home that afternoon or evening. This is also called Day-case Joint Replacement.
In majority of these procedures, patients are going home within 24 hours of surgery with good mobilization, with or without the aid of crutches with minimal discomfort and less restrictions.
Although patients are ready to be discharged home by the afternoon – some patients prefer to spend the night and then go home the following morning mostly for convenience and some patients may have to travel a few hours to their hometown or suburbs.
Most of these patients are also driving within 1-2 weeks of joint replacement surgery as per our published studies.
We have the infrastructure for day surgery joint replacement in place to send patients home the same day, however it is the hospital and fund agreements that prevents us from doing so.
What are the Advantages of Day Surgery Joint Replacement?
- Early Mobilization
- Rapid Recovery from surgery
- Less potential risk of DVT/PE – blood clots as the most important factor is early mobility
- Minimally invasive surgery – less pain, swelling and faster recovery
What may be potential disadvantages of Day surgery joint replacement?
- Patients may feel “rushed” after joint replacement surgery – but patient education and meeting expectations are important aspects to cover before surgery
- Patients may have to be re-admitted, only if they cannot cope at home but in most instances, it may be less than 3% from most studies.
What Patients are eligible for Day case joint replacement or 24 discharge joint surgery?
- Patients with no significant medical – heart, lung, kidney or liver issues
- American Society of Anaesthesiology (ASA) score of 2 or below
- Patients who are not on any blood thinners (anticoagulants) for medical reasons
- Patients not taking any long term steroids or history of Diabetes
- Patients who do not pose a risk for anaesthetic issues
- Patients who have a Body Mass Index (BMI) less than 35
- Pre surgery Haemoglobin of over 13.5 g/dl
- No past history of DVT or PE
- Patients should have no cognitive or memory impairement
- Patients who are Not using walking aids before surgery
- Patients who have good home support when they are discharged home
Day Surgery Joint Replacement Patient Education
Before surgery we spend a lot of time educating all patients about surgical expectations. It is important they understand they are having major surgery but they will be able to mobilize confidently. They have to make sure there is someone at home to look after them when discharged and our team do everything possible with booklets and patient education and nursing support to make this experience less anxious.
Anaesthesia and analgesia for Day Case Joint Replacement
Patients usually have a combined spinal and light general anaesthetic so patients can mobilise 2-3 hours after surgery, so they feel comfortable and confident walking.
Surgical Technique and prevention of Blood loss
We make every effort to ensure minimally invasive surgery is instituted in all surgical cases. In other words, there is minimal tissue dissection which reduced the amount of swelling after surgery which in turn reduces pain and discomfort which in turn enables rapid and early mobility after surgery.
When do patients drive after minimally invasive anterior hip replacements? A single surgeon experience of 212 hip arthroplasties
www.ncbi.nlm.nih.gov/pmc/articles/PMC6250078/
Early resumption of driving within 3 weeks following patient-specific instrumented total knee arthroplasty: an evaluation of 160 cases
www.jisakos.bmj.com/content/4/2/88
However, the Hospitals and Health funds may have issues with day case joint replacements as the hospitals may not be funded for this although the patient is ready for discharge.
The day case joint replacement program will be introduced soon in select hospitals in select patients only.
