A multidisciplinary enhanced recovery programme allows discharge within two days of total hip replacement
This study presents three- to five- year results of 100 sequential patients undergoing total hip replacement (THR) through a multidisciplinary rapid recovery programme, with mean length of stay (LOS) 1.99 nights. Patients attend pre-admission ‘bone school’, with talks and assessments by the senior sister, physiotherapist and occupational therapist. All received an uncemented Corail-Pinnacle THR via piriformis-sparing mini-posterior approach. ‘Low dose’ spinal plus light general anaesthesia offers sensory block whilst retaining motor function; pain free mobilisation is predictably achieved within a four hours. Following radiograph and haemoglobin check the following morning, patients were discharged upon meeting specific nursing/physiotherapy criteria. Those within 20 miles received outreach follow-up. Follow-up assessment was undertaken using SF36, Visual Analogue, Merle d’Aubigné-Postel and Oxford Hip Scores. Mean age was 65 years (25-91), mean BMI 28.7 (19-43). ASA ranged 1-3 (mode 2), Charlson comorbidity index from 0-9 (mode 3). Major complications were: one dislocation with deep infection, one myocardial infarction, one trochanteric bursitis requiring exploration, one ceramic fracture, and three metal debris reactions. Several more minor complications occurred. LOS was longer in older patients (p = 0.03) and those with higher Charlson index (p = 0.02). Eighty-two patients remain under follow-up, (mean 37.8 months, range 36-61). Six have died; five underwent revision; seven have moved away or been lost. Ninety-seven percent remain quite or very satisfied. This LOS is amongst the shortest in the United Kingdom, with encouraging outcomes. The SSP succeeds by involving all team-members and managing patient expectations. At a time of limited healthcare resources the authors propose that their SSP could readily be reproduced in other places with similar benefits.