Enhanced Recovery (Rapid Recovery Joints) Programme
Enhanced Recovery often referred to as Rapid Recovery Joint Replacement has been around for over 14 years. It is NOT a New Technique but an Enabling Process.
The Enhanced / Rapid Recovery Joints Programme was developed in Sydney By Professor L. Kohan and Dr. Dennis Kerr. Dr. Nizam has been a part of this team working closely with them for over 7 years conducting several research projects and written research articles on this programme. (read more)
Enhanced Recovery or Rapid Recovery Programme:
- Reduces physical and psychological Trauma of Surgery.
- Less Pain after Surgery
- Less Nausea and Vomiting
- No Drug Side-Effects or Sedation
- Rapid and Improved Rate and Quality of Recovery
- Less Muscle Weakness
- Patients being able to Walk within 4 hours after joint replacements
- Less Post Surgical Complications (deep vein thrombosis, pulmonary embolism and infections)
- No Inpatient Rehab
- No Urinary Catheters
- Discharged Home after a Single overnight stay in hospital. (Individual outcomes may vary)
The key elements included in the Enhanced Recovery after Joint Replacement surgery pathway are:
- Patient Education (especially joint school)
- Preoperative nutrition
- Active peri-operative oxygenation
- Active prevention of hypothermia during and after surgery
- Regional anaesthesia to enable early and independent mobilisation
- Minimally Invasive Surgery and control of blood loss
- Avoidance of peri-operative encumbrances e,g, drains, epidural catheters, pca’s – these “attach” the patients to a bed and prevent mobility
- No systemic morphine use (to avoid drowsiness, Sickness and Nausea after surgery)
- Enhanced preoperative and postoperative nutrition
- Early post-operative mobilisation
- Early Discharge home when safe, so patients are able to recover in their own home environment
- Less Risk of Infection and DVT / PE
This Program involves:
Pre-operative Patient Education:
This is a crucial part of our clinical pathway adopted to enhance early functional recovery and hospital discharge after surgery. Here we consider patient expectations and educate the patient/family about joint replacements, the benefits and risks of surgery and the benefits of early mobilization,recovery and early home discharge. Building patient confidence and motivation from the beginning is important and we help through this process. This also helps to relieve unnecessary patient anxiety and any misconceptions.
Pain is a distressing symptom which can affect recovery, reduce patient satisfaction and prolong hospitalization. Patient anxiety related to pain perception is another factor that can also affect recovery. So preoperative painrelief (analgesia)is given to reduce this anxiety which can also modify peripheral pain stimulation. The whole aim is to reduce pain perception after surgery so the patient is able to recover comfortably almost pain free (individual results can vary).
Peri-operative analgesia with LIA
What Is LIA? : Local Infiltration Analgesia
This is a Multimodal Pain Management process that enables early independent mobilization after major orthopaedic procedures (such as joint replacements) as early as 4 hours after surgery.
The first part involves injecting a mixture of local anaesthetic and other agents into the operative site at the time of surgery, in essence to “numb” that part so that after surgery the patient is comfortable with less discomfort or pain. The details of this will be discussed in detail at consultation.
This will enable you to walk within 4 hours after joint replacements with less pain, discomfort and rapid recovery.
An indwelling catheter (tubing) willremain in situ that can later be topped up to minimize pain in the immediate post-surgical phase. The pain-catheter is removed within 24 hours before being discharged home after 1 overnight stay in hospital.
Other pain medications are also given after surgery to minimize pain and maintain activities of daily living and ensure that patients are comfortable at all times. In the majority of cases, patients will be discharged home the following day after Joint replacement with crutches.
It is important that patients understand our Enhanced recovery program and what is to be expected so patients are motivated to get the best outcome from surgery.
All patients will be given detailed information regarding the surgical procedure, its implications and outcomes before embarking on any surgery and any non-surgical options also discussed.
To see how successful LIA is, see the Current Affairs program
What Procedures Can Enhanced Recovery Program be applied to?
- All Joint Replacements (Hip Replacements and Knee Replacements)
- Hip Resurfacings
- ACL Reconstruction
- Fractured Hips – after surgery, especially if patients had a partial or total hip replacement
- Revision Surgery of the Hip and Knee Joints
It can be applied to arthroscopic (key hole) surgery as well.
Will every patient after joint replacement surgery go home the next day?
The main aim of our pain management protocol is to enable patients to return to their home environment doing activities of daily living as soon as possible.
The majority of patients will be able to go home the next day, some have actually gone home the same day, but they are younger, fit patients who are very motivated.
The factors that determine early discharge are patient physiology after surgery (status of blood pressure, blood transfusion requirements, fluid balance, etc) and also the presence of a carer at home. We have avoided using narcotics in the early phase of our program to avoid sedation that slows down early independent mobilization.
Another reason for discharge after an extra day in hospital is because some Private Health Funds will not pay the Hospital for “Joint Replacement” as they (Health Funds) classify joint replacements as major surgery requiring at-least 3-7 days hospital stay. Patients can check with their health funds, and hospitals usually work together with the patients and surgeons to provide the best outcome. If this is the case, patients can certainly be “street ready” the day after surgery and go home or outside on “gate-leave”.
This program is most importantly, Good for the Patient, Good for the Surgeon, Good for the Hospital (frees up beds for other patients who may need emergency surgical care, etc) and Good For the Health Funds.
- 76F, 4 hours after traditional left hip replacement surgery mobilizing with a frame
- 70M, 3-4 hours after traditional total hip replacement walking independently with a frame