Abstract
Introduction
Typical UK patients spend 5–7 days in hospital following total hip replacement (THR). Decreasing length of stay (LOS) increases throughput and reduces cost. We have developed a short stay THR programme (SSP), which has been used in all patients since May 2006; we present the first 100.
Methods
Every patient undergoing THR is included in the dataset. All attend ‘bone school’ before admission, with talks and individual assessments by the senior sister, physiotherapist and occupational therapist. Medical concerns are discussed with an anaesthetist. Patients receive training with crutches; crutches are provided for home practice.
All receive an uncemented Corail-Pinnacle THR via piriformis-sparing mini-posterior approach. ‘Low dose’ spinal plus light general anaesthesia provides sensory block whilst retaining motor function; painfree fully weightbearing mobilisation is predictably achieved within four hours. Following radiograph and haemoglobin check next morning, patients are discharged on meeting specific nursing/physiotherapy criteria. Those within 20 miles receive outreach follow-up. Follow-up assessment is undertaken using SF36, Visual Analogue, Merle d'Aubigné-Postel and Oxford Hip Scores.
Results
Mean age was 65 years (25–91), mean BMI 28.7 (19–43), mean ASA 1.97 (1–3). Major complications were: one dislocation, one deep infection, one myocardial infarction. Several more minor complications occurred. Mean LOS was 1.99 nights (1–19). One patient was readmitted with wound ooze. No association existed between LOS and ASA/age.
82 patients remain under follow-up, (mean 37.8 months, range 36–61). Seven have died; four underwent revision; seven have moved away or been lost. 97% remain quite or very satisfied.
Discussion
We believe our LOS to be amongst the shortest in the country, with favourable clinical results. The SSP succeeds by involving all team-members throughout, and managing patient expectation. At a time of limited healthcare resources we propose that our SSP is totally reproducible, and could readily be established elsewhere with similar benefits.
