85% of Patients Leave Hospital within 24 hours of Surgery
Updated 10/1/2014
Hip resurfacing and single compartment knee replacement patients at home
within 24 hours by Dr. Kohn of Australia
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Patients with osteoarthritis are not ill – this is the fundamental principle
on which we have established a treatment concept in line with the patients’
needs in the Joint Orthopaedic Centre over the last 10 years.
Here in Sydney we have a dedicated team bringing together surgical, anesthetic
and nursing skills to benefit our patients.
85% of all patients we treat with either a single compartment knee replacement
or hip resurfacing leave the hospital within 24 hours of the operation and go
straight home, not to a rehabilitation centre.
Information first
The first step in a treatment program is to provide the patients with
comprehensive information. We must get across to the patients that many of their
fears, preconceptions, and much of what they have heard about joint replacement
surgery has nothing to do with the treatment they will receive in our clinic.
Pre-operative fear is a problem to be taken seriously, which we do.
Minimally invasive
The second step is to select an implant that is not only stable but can bear
weight immediately.
The third step is an operative procedure that is preferably minimally invasive.
The less tissue damage there is, the less pain the patient will feel. The
operation must be performed carefully and gently so that bleeding is minimized,
pain is diminished and recovery and mobility are maximized
Pain control
Fourthly we make use of pain control that initially includes
a local anesthetic injection around the operation site, so that the first
painful stimulus is eradicated or minimized. This is just like the dentist
minimizing pain at the site of dental work. This is then supplemented with a
combination of paracetamol, codeine and anti-inflammatory agents used in the
immediate postoperative period. A short-acting spinal anesthetic is used, not
an epidural anesthetic. Our experienced anaesthetist works with the smallest
possible dosages and uses as few narcotic agents as possible because these can
cause nausea and confusion and delay mobilization. Because of the effective
local anesthetic block pain relief is generally good enough not to require
intramuscular narcotics or patient controlled analgesic infusions. We like our
patients to be on their feet again and walking as soon as possible and strongly
encourage this. Generally, they should be mobile again and weight bearing within
four hours of the operation.
Home circumstances paramount
And last but not least, the patient’s home circumstances are also considered.
This is paramount in achieving a smooth transition from hospital to home. We try
to ensure that the patient has a relative or friend to stay over during the
first postoperative night, if there are no family members there. Whether the
patient has to climb stairs, the presence of obstacles such as loose rugs, how
far away the toilet facilities are, these are all factors which were discussed
before the operation, and addressed. It is important that any potential problems
and concerns are anticipated and dealt with before a return home is considered.
Over 1300 patients treated
85% of the patients who have had this treatment program have returned home
within 24 hours. We have now been applying this short stay surgical procedure
program for over eight years, and have treated over 1300 patients with hip and
knee problems.
Complications have been few. We have had 2 non-fatal pulmonary emboli. In the
650 unicompartmental knee resurfacings there have been no emboli at all. Looking
at all the operations, seven superficial infections occurred which were treated
with antibiotics, and none required removal of the prosthesis.