Updated 10/1/2014 Hip resurfacing and single compartment knee replacement patients at home within 24 hours by Dr. Kohn of Australia Click Here to Read Original Link 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.