The aim of this study was to evaluate the impact of a preoperative education programme on length of hospital stay for primary and revision knee arthroplasty patients.

The programme was introduced at our hospital in October 2006 to encourage patients to play an active role in their postoperative recovery process. It was delivered by a multi-disciplinary team consisting of an arthroplasty nurse, ward physiotherapist, occupational therapist and orthopaedic consultant. Patients were educated about their care pathway, knee surgery, pain management, the expected discharge goal, post operative inpatient and outpatient rehabilitation. Data was prospectively reviewed for 472 patients who underwent (primary or revision) knee arthroplasty for the period between January 2006 and November 2007. There were 150 patients in the Conventional group and 322 patients in the Educational group. The mean length of stay reduced significantly from 7 days in the Conventional group to 5 days in the Education group (P< 0.01). In addition 20 percent more patients were discharged early (within 1 to 4 days) in Education group compared to the Conventional group (P< 0.01). There was no statistically significant difference in the percentage of inpatient complications and readmissions between the two groups.

Our study demonstrates that preoperative education is a safe and effective method of reducing length of stay for knee arthroplasty patients. Significantly more patients achieved discharge within four postoperative days.

There are about 63,000 primary total knee replacements done annually in England and Wales. One of the biggest challenges of modern NHS is to ensure high quality care for the patients. A reduced length of stay in the hospital following primary total knee replacements could be the key factor in significant cost reduction.

The aim of the study was to assess the efficacy of our rapid recovery programme following total knee replacements in terms of reducing length of stay, morbidity, complications, and readmissions rates.

A prospective study of 252 patients who underwent primary total knee replacement for a period of one year between October 2006 to 2007 were included in the programme. There were 123 (49%) males and 129 (51%)females. The average age was 71 (range-53 to 86). The average BMI was 30 (range-22 to 46). The median ASA grade was 2 (range-1 to 4). There were no exclusion criteria. The programme included pre-operative education of patient and relatives, standardised operation protocols, infection control, pain management, continuous motivation by nursing staff and physiotherapists in the ward as well as intensive rehabilitation by a community based physiotherapy team in patient’s own environment. The patients were discharged when they had achieved the ward physiotherapy requirements.

The average length of stay was 5.2 days. The complications encountered during inpatient stay was wound discharge(43), surgical site infection(1), DVT (1), pneumonia(1).12 patients needed post operative blood transfusion. The readmissions rate was 4%. Deep infection was noted in 4 patients, DVT(1), pulmonary embolism(1)and 3 patients had medical complications.

In conclusion the rapid recovery programme following total knee replacement is an efficient method of speeding the recovery and reducing the length of hospital stay after primary knee replacements. It is useful for the modern NHS to achieve a balance between financial savings and a consistent, responsive and high-quality care for patients.