We report the impact of implementing a new short-stay hip and knee arthroplasty pathway in a National Health Service (NHS) hospital. This was enacted due to existing concerns with a long length of stay (LOS) and reduced elective operating capacity each winter due to emergency bed pressures. The overnight introduction of this pathway was aimed to reduce LOS, alleviate bed pressures, minimise readmission rates and generate financial savings, all combining to facilitate full elective activity during the winter. We conducted a prospective study at a regional tertiary arthroplasty centre. The new pathway was introduced across the service overnight. It includes rigorous preoperative optimisation, specific anaesthetic protocols and uniform changes in surgical practice to allow a focus on early mobilization and discharge on the day of surgery where possible. Data collection spanned 17 months, including the initial six months post implementation of the short-stay pathway. LOS data was collected for the full period and data was compared pre- and post-implementation of the new pathway. Patient satisfaction and 30-day readmission data were also collected. There was an immediate and significant decrease in median LOS from 4 days pre-implementation to 1 day post-implementation. Patient satisfaction was high, and the 30-day readmission rate was unchanged (5.95%), with no readmissions directly related to decreased inpatient stay. Financial analyses revealed substantial cost savings due to reduced LOS and the elimination of routine post-operative blood tests, estimated at over £1.6m per year. Elective activity over winter was significantly higher (79%) than in the same time period in the previous year. An acute introduction of a carefully planned and coordinated short-stay hip and knee pathway is safe, cost-effective and popular with patients, but also contributes to increased efficiency in the delivery of elective healthcare in the context of increasing demand and financial constraints in the NHS.
It is common practice for patients to have postoperative blood tests after total joint replacement (TJR). However, there have been significant improvements in perioperative care with arthroplasty surgery, and a drive to reduce the length of stay (LOS) and move towards day-case TJR. We should reconsider whether this intervention is necessary for all patients. This retrospective study included all patients who underwent a primary unilateral TJR at a single tertiary arthroplasty centre during a one-year period. Electronic medical records of 1,402 patients were reviewed for patient demographics, LOS, and American Society of Anesthesiologists (ASA) grade. Blood tests were examined to investigate the incidence of postoperative anaemia, electrolyte abnormalities, and incidence of acute kidney injury (AKI).Aims
Methods
It is common practice for all patients to have postoperative bloods tests after total knee arthroplasty (TKA). However there have been significant improvement in perioperative care with arthroplasty surgery. As healthcare systems and providers strive towards a more efficient service we must re-consider whether such an intervention is necessary for all patients. This retrospective study included all patients who underwent a primary unilateral TKA at a single tertiary arthroplasty centre during a 1 year period. Electronic medical records of 776 patients were reviewed for patient demographics, length of stay and American Society of Anaesthesiologists grade. Blood tests were examined to investigate the incidence of post operative anaemia requiring transfusion, electrolyte abnormalities that required treatment and the incidence of acute kidney injury.Abstract
Introduction
Methodology
Wear measurements of 100 explanted hips have been carried out on a Taylor Hobson 365 Roundness Machine using the LIRC Wear Protocol. It was found that 50% of explanted cups were wearing less than 5 μm/year and 60% of components were wearing less than 10 μm/year. Wear tests on hip joint simulators predict wear rates between 2 and 8 μm/year. However, 6% of cups are wearing faster than 100 μm/year, with 16% of cups have wear patches deeper than 100 μm and that 4% have a wear patch deeper than 300 μm.
Cup position is an important factor, all of the high wearing components are outside the Lewinick’s Box, however it is shown that mal position is does not always lead to extreme wear. Further analysis is taking place to calculate the size of the contact patch between head and cup (based on patient data and biomechanics) and the proximity of the contact patch to the edge of the cup.
