Improving patient care with hip replacement day surgery

Anne-Marie Hefferan was in hospital for just a day, from 7am to 8.30pm

An innovative new way of working at Oxford University Hospitals (OUH) means patients needing planned hip replacements can be operated on and return home the same day.

Day case surgery of this kind dramatically reduces the overall length of stay for patients at the Oxford-based Nuffield Orthopaedic Centre (NOC), run by OUH, from around four days to a single day.

This improves the efficiency of the Orthopaedic team, makes better use of hospital resources, reduces complications and stress for patients, and improves patient experience.

With the first day case hip replacement taking place in June 2020, as of 1 December 2020, more than 30 patients have received a hip replacement, recovered, and been discharged in the same day.

There are only a small number of Trusts across the UK that can provide this service in this timescale. Three or four patients can go through the day case hip replacement pathway in a single day.

Simon Newman, a Consultant Orthopaedic Surgeon at the Trust, said: "Being able to provide day case hip replacements is a massive achievement for OUH, and we are very proud to be one of a small number of NHS trusts to perform this type of service for patients.

"With modern techniques and support, it is now possible for patients to have the operation and go home the same day, meaning patients are now in control of their own recovery and the risks of medical complications are reduced."

The first day case hip replacement took place in July 2020 as elective surgeries across the Trust resumed following the first national lockdown.

Patient Anne-Marie Hefferan, who has had both hips replaced, was diagnosed in March 2019 with bilateral hip arthritis – likely osteoarthritis – and had been experiencing mobility issues and pain for about two years.

The 52-year-old from Stanford in the Vale had her right hip replaced in January 2020 with a four-day hospital stay. However, when Anne-Marie had her left hip replaced in July 2020 as part of the new day case service, she was in hospital for just a day, from 7am to 8.30pm.

She said: "The day case service was excellent from start to finish. The benefit of this service is that you are back home the same day so you get better sleep and feel more relaxed in your home environment.

"All these factors are so important for recovery. I was constantly reassured that I would benefit from being active as soon as possible post-operation and I agree with this from this experience compared to the previous operation.

"My health and quality of life is so much better. I no longer have the need to take painkillers and my mobility is much better and improving all the time due to daily physio exercises and dog walking.

"The care was excellent from all the staff at the NOC, and I could not fault anything. I would like to thank the staff for the great job they are doing."

A hip replacement is usually carried out when the joint is worn and pain restricts mobility. The benefits of surgery include reduced pain, improved flexibility, and increased mobility. However, patients need to be relatively fit for day case surgery and not every patient having a hip replacement is suitable for this type of treatment.

Paul Beckett, another patient, had a worn out hip, causing a limp and pain in his knee and hip, and needed it replaced.

The 65-year-old from Bicester was in hospital for 12 hours when he received his treatment in August 2020.

Paul, a furniture maker and antique restorer, is now feeling much better and able to continue with his work.

He said: "I was able to get home into the comfortable surroundings of my own home which improved my wellbeing and sped up my recovery. Every step of the care that I received was explained and I could always ask questions to reassure me of the procedure.

"I cannot thank the team enough for the quality of life that they have given me, as I love my work and will be able to continue as a result of the operation. I know they are only doing their job, but all the care and expertise they have given me has been immense."

Becky Easton, Matron of the Trauma and Orthopaedic Directorate at the Trust, said: "I am so proud of the whole team that has successfully implemented this new pathway at the Nuffield Orthopaedic Centre.

"This includes the physiotherapists who have radically changed their working patterns, the anaesthetists who have developed new methods to allow patients to walk earlier after their operation and, of course, the nursing team that has stepped up its support for patients before, during, and after their stay in hospital.

"The entire hospital staff, including surgeons, occupational therapists, pharmacists, and radiographers, have embraced this new way of working and have proactively worked with patients to facilitate day case hip surgery.

"Patients often feedback that they want to get home as soon as possible and this is even more relevant during the COVID-19 pandemic.

"The benefits to patients are that they are able to get home into familiar surroundings as soon as it is safe for them to do so, and this is even more important during a pandemic.

"This fantastic achievement would not have been possible without the hard work and ‘can do' attitude of our brilliant orthopaedic team members. I am really proud of the team’s passion and dedication to improving patient care."

Oxford Hospitals Charity, which raises funds to support all the hospitals at OUH, funded a number of specialist reclining chairs to help patients regain their mobility following their surgery.

Douglas Graham, Chief Executive Officer of the charity, said: "It is fantastic to hear about these exceptional innovations, and our charity is delighted to have funded these chairs that help patients during recovery and provide a little extra comfort before they go home.

"This is just one of a number of initiatives we have funded recently at the NOC thanks to the generosity of our donors."