• Patient education (especially joint school)
• Preoperative nutrition
• Premedication
• 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, as they ’attach’ patients to a bed and prevent mobility
• No systemic morphine use (to avoid drowsiness, sickness and nausea after surgery)
• Enhanced pre-operative and post-operative nutrition
• Early post-operative mobilisation
• Early discharge when safe, so patients are able to recover in their own home environment
• Less risk of infection and DVT/PE

Pre-operative patient education:

This is a crucial part of our clinical pathway, adopted to enhance early functional recovery and 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 mobilisation, recovery and early discharge. Building patient confidence and motivation from the beginning is important and we help with this process at all stages. This also helps to relieve unnecessary patient anxiety and any misconceptions.

Pre-emptive analgesia:

Pain is a distressing symptom which can affect recovery, reduce patient satisfaction and prolong hospitalisation. Patient anxiety related to pain perception is another factor that can affect recovery, so pre-operative pain relief (analgesia) is given to reduce this anxiety, and can also modify peripheral pain stimulation. The whole purpose is to reduce pain perception after surgery so the patient is able to recover comfortably, almost pain free. (individual results can vary).

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.