Enhanced Recovery after Surgery

Hip and Knee Replacement operations are now very routine but are still major procedures that result in blood loss and recovery can be painful. It sounds obvious that pain and blood loss are bad for the body but it has been shown that by reducing this surgical ‘hit’ on the body, patients recover better. In fact by using a range of measures we can reduce your stay in hospital and also reduce the risk of heart attack, blood transfusion and the risk of dying.

These measures are known as Enhanced Recovery. At the Hip and Knee clinic we practice Enhanced Recovery and by using a range of modern techniques we can reduce your pain and speed up your recovery from surgery.

The Principles Behind ‘Enhanced Recovery’ Are:

Patient Expectations

It is vital that patients know what to expect before they come in for surgery. There is a lot of information around from the internet, relatives, friends and sometimes other doctors and it isn’t always accurate. If patients are given the correct information they are less anxious about their operation and are confident to mobilise quickly after surgery and can often get home after 1-2 days.

Preoptimise Patient Before Surgery

This involves making sure patients are fit for their surgery including correcting anemia and kidney problems. In some cases we can give preoperative carbohydrate loading drinks to speed up recovery.

Multimodal Analgesia

Pain is reduced more effectively by giving several different types of painkillers. This reduces the side effects associated with morphine and means that patients are more likely to mobilise quickly. We recommend a spinal anesthetic with sedation as this gives very good pain relief postoperatively and means we can avoid the strong morphine painkillers that make patients feel sick and very drowsy. We also use preoperative medications, long acting local anesthetics given during surgery, regular post operative painkillers and cryotherapy (cold compress bandages on the wound).

Minimise Blood Loss

We can minimise blood loss with careful surgery, specific anesthetic techniques and drugs that stop bleeding that are given through the drip and into the wound.

Early Mobilisation

It is really important that patients mobilise quickly after surgery. This can be as early as the same day or day after the operation. Early mobilisation reduces the chance of blood clots (Deep Vein Thrombosis), reduces the risk of pressure sores and chest infections.

Avoid Drips & Drains

At the Hip and Knee clinic we do not use wound drains for joint replacement surgery as they do not improve your outcome and make walking more difficult after surgery.

Enhanced Recovery after Surgery

Hip and Knee Replacement operations are now very routine but are still major procedures that result in blood loss and recovery can be painful. It sounds obvious that pain and blood loss are bad for the body but it has been shown that by reducing this surgical ‘hit’ on the body, patients recover better. In fact by using a range of measures we can reduce your stay in hospital and also reduce the risk of heart attack, blood transfusion and the risk of dying.

These measures are known as Enhanced Recovery. At the Hip and Knee clinic we practice Enhanced Recovery and by using a range of modern techniques we can reduce your pain and speed up your recovery from surgery.

The Principles Behind ‘Enhanced Recovery’ Are:

Patient Expectations

It is vital that patients know what to expect before they come in for surgery. There is a lot of information around from the internet, relatives, friends and sometimes other doctors and it isn’t always accurate. If patients are given the correct information they are less anxious about their operation and are confident to mobilise quickly after surgery and can often get home after 1-2 days.

Preoptimise Patient Before Surgery

This involves making sure patients are fit for their surgery including correcting anemia and kidney problems. In some cases we can give preoperative carbohydrate loading drinks to speed up recovery.

Multimodal Analgesia

Pain is reduced more effectively by giving several different types of painkillers. This reduces the side effects associated with morphine and means that patients are more likely to mobilise quickly. We recommend a spinal anesthetic with sedation as this gives very good pain relief postoperatively and means we can avoid the strong morphine painkillers that make patients feel sick and very drowsy. We also use preoperative medications, long acting local anesthetics given during surgery, regular post operative painkillers and cryotherapy (cold compress bandages on the wound).

Minimise Blood Loss

We can minimise blood loss with careful surgery, specific anesthetic techniques and drugs that stop bleeding that are given through the drip and into the wound.

Early Mobilisation

It is really important that patients mobilise quickly after surgery. This can be as early as the same day or day after the operation. Early mobilisation reduces the chance of blood clots (Deep Vein Thrombosis), reduces the risk of pressure sores and chest infections.

Avoid Drips & Drains

At the Hip and Knee clinic we do not use wound drains for joint replacement surgery as they do not improve your outcome and make walking more difficult after surgery.

Mr Symes is the leading surgeon in the area for Enhanced Recovery and developed the ERAS pathway at Hull and East Yorkshire Hospitals. He is now working on a further development of the pathway to improve patients care.

References

Savaridas T, Serrano-Pedraza I, Khan SK, Martin K, Malviya A, Reed MR. Reduced medium-term mortality following primary total hip and knee arthroplasty with an enhanced recovery program. A study of 4,500 consecutive procedures. Acta Orthop.2013 Feb;84(1):40-3.

Khan SK, Malviya A, Muller SD, Carluke I, Partington PF, Emmerson KP, Reed MR. Reduced short-term complications and mortality following Enhanced Recovery primary hip and knee arthroplasty: results from 6,000 consecutive procedures. Acta Orthop. 2014 Feb;85(1):26-31

Mr Symes is the leading surgeon in the area for Enhanced Recovery and developed the ERAS pathway at Hull and East Yorkshire Hospitals. He is now working on a further development of the pathway to improve patients care.

References

Savaridas T, Serrano-Pedraza I, Khan SK, Martin K, Malviya A, Reed MR. Reduced medium-term mortality following primary total hip and knee arthroplasty with an enhanced recovery program. A study of 4,500 consecutive procedures. Acta Orthop.2013 Feb;84(1):40-3.

Khan SK, Malviya A, Muller SD, Carluke I, Partington PF, Emmerson KP, Reed MR. Reduced short-term complications and mortality following Enhanced Recovery primary hip and knee arthroplasty: results from 6,000 consecutive procedures. Acta Orthop. 2014 Feb;85(1):26-31