Aims

Unicompartmental knee arthroplasty (UKA) has been successfully performed in the United States healthcare system on outpatients. Despite differences in healthcare structure and financial environment, we hypothesised that it would be feasible to replicate this success and perform UKA with safe day of surgery discharge within the NHS, in the United Kingdom. This has not been reported in any other United Kingdom centres.

Unicompartmental knee replacements offer improved function with more rapid recovery compared to TKR. There is no published experience with introducing this procedure as a day case in the UK. We report on our experience with a new protocol allowing the patient to be discharged on the day of surgery.

A new combination of anaesthetic and surgical techniques are employed. Paracetamol, ibuprofen and pregabalin are given pre-operatively. Patients receive a GA and a subsartorial saphenous nerve block is administered under ultrasound control. The surgery is performed using a routine minimally invasive technique. The joint and surrounding tissues are infiltrated with a combination of LA and adrenaline. Wound closure is with subcutaeneous suture and tissue glue.

Patients are mobilised on the day of surgery and if comfortable discharged on paracetamol, codeine, ibuprofen, tramadol P.R.N and buprenorphine patch.

Length of stay, pain scores, presence of nausea/vomiting, dizziness, drowsiness, post-operative bleeding and patient satisfaction are all recorded.

18 out of 19 patients have been discharged on the day of surgery. All record high satisfaction.

Patients can be safely discharged on the day of surgery after UKR with high levels of satisfaction. We believe we are the first unit in the UK to achieve this.

Objective: The aim of this prospective observational study was to evaluate the feasibility of performing ACL reconstruction with femoral nerve block as a day-case procedure, implement the necessary changes and audit the outcomes following instigation of a day-case protocol.

Methods: From November 2005 to April 2006 all patients undergoing ACL reconstruction were entered into a day-case feasibility study. Any issues preventing day-case discharge were identified, and in November 2006 changes were implemented to address these. Since then all ACL reconstruction patients have been treated as day-cases using femoral nerve blocks. Patients are discharged if safe, and contacted 1 and 7 days postoperatively to detect any problems and to assess patient satisfaction. Patients undergoing ACL reconstruction with femoral nerve block in the independent sector, by the same surgeon but without a strict protocol were used as a comparison group.

Results: 18 patients have followed the day-case pathway, 15 (83%) being discharged as day-cases. The other cases had afternoon surgery delaying discharge. Only 25% (3/12) patients treated in the independent sector were discharged on the day of surgery. All patients had good working femoral nerve blocks, were able to mobilise safely with crutches and reported no adverse effects from their blocks at follow-up phone calls. All reported good analgesia at home and high satisfaction with being a day-case.

Conclusions: With appropriate education of patients and staff, and following a day-case protocol, ACL reconstruction with femoral nerve block is a safe day-case procedure with high patient satisfaction.

Objective: The aim of this prospective observational study was to evaluate the feasibility of performing ACL reconstruction with femoral nerve block as a day-case procedure, implement this change and audit our outcomes.

Methods: From November 2005 to April 2006 all patients undergoing ACL reconstruction were entered into a day-case feasibility study. Any issues preventing day-case discharge were identified, and in November 2006 changes were implemented to address these. Since then all ACL reconstruction patients have been treated as day-cases using femoral nerve blocks. Patients are discharged if safe, and contacted 1 and 7 days postoperatively to detect any problems and to assess patient satisfaction.

Results: 23 patients have followed the day-case pathway, 15 being discharged as day-cases. The other cases had afternoon surgery delaying discharge or surgery in the independent sector where the protocol was not enforced. All patients had good working femoral nerve blocks, were able to mobilise safely and easily with crutches and reported no adverse effects from their blocks at follow-up phone calls. All reported good analgesia at home and high satisfaction with being a day-case.

Conclusions – With appropriate education of patients and staff, ACL reconstruction with femoral nerve block is a safe day-case procedure with high patient satisfaction.