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 he has written research articles on this programme. (read more)
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.
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).
This is a multimodal pain management process that enables early independent mobilisation 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 to numb that part, so that after surgery the patient is comfortable with less discomfort or pain This will be discussed in detail at consultation.
This will enable you to walk within 4 hours after joint replacements with less pain and discomfort and rapid recovery.
An indwelling catheter (tubing) will remain in situ and can later be topped up to minimise pain in the immediate post-surgical phase. The patient’s catheter is removed within 24 hours before being discharged after 1 overnight stay in hospital.
Other pain medications are also given after surgery to minimise pain and maintain activities of daily living, and to ensure that patients are comfortable at all times. In the majority of cases, patients will be discharged the following day after, with crutches.
It is important that patients understand our Enhanced Recovery Program and what is to be expected so that they are motivated to get the best outcome from surgery.
To see how successful LIA is, see the Current Affairs program:
It can be applied to arthroscopic (keyhole) surgery as well.
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
