Introduction and Aims Unicompartmental knee arthroplasty (UKA) is appropriate for one in three osteoarthritic knees requiring replacement. An accelerated protocol enables patients undergoing UKA to be discharged within 24 hours of surgery. Before such an approach is universally accepted it must be safe, effective and economically viable. A study was performed to compare the new accelerated protocol with current standard care in a state healthcare system.

Method A single blind RCT design was used. Patients eligible for UKA were screened for NSAID tolerance, social circumstances and geographical location before allocation to either an accelerated recovery group (Group A) or a standard non accelerated group (Group S). The accelerated protocol included dedicated pain management and discharge support. Primary outcome was the Oxford Knee Assessment at 6 months post operation, compared using independent t tests. Pain, range of movement and incidence of complications were also recorded by assessors blind to group allocation. Cost effectiveness was calculated in quality life adjusted years (QLAY) using the Euroqual instrument. The study power was sufficient to avoid type 2 errors. The study was supported by a NHS Regional R& D grant.

Results Forty one patients (21 group A, 20 group S) were included. Groups had comparable age and patient profiles. Average discharge time was 37 hours (1.5 days) for group A and 114 hours (4.3 days) for group S. Pain on hospital discharge was similar for both groups. No significant difference was found between groups for pain or range of movement at any time, although patients in group S regained pre-operative flexion faster than group A. One major complication occurred in each group; one infection (group S) and one manipulation for poor movement (group A). The cost per QLAY for the new protocol was 59% of the standard care.

Conclusion The new protocol allows for safe accelerated discharge from hospital after UKA. The approach is cost effective and should help to increase the throughput of patients who require knee replacement.

Purpose – Improve health professionals’ knowledge and understanding of patients’ perspectives of a randomised controlled trial of accelerated discharge following elective orthopaedic surgery.

Methods/Design – A qualitative study using purposive sampling and in-depth, semi-structured interviews was carried out with 16 patients who were approached about taking part in a randomised controlled trial comparing accelerated discharge within 24 hours with conventional management. Nine patients who consented and seven who declined the trial were interviewed; the interviews were tape recorded, transcribed and analysed thematically.

Main results – Patients who entered the trial did so because they were attracted by the possibility of early discharge and for altruistic reasons of helping medical research. Those who refused did so because they worried that they would not have the required domestic assistance at home.

Conclusions – Most people who took part in this trial expressed satisfaction. The accelerated discharge option was not seen to be disadvantageous. Those who refused did so for social rather than medical reasons. With the increase in early discharge schemes this social concern will have to be addressed if patients’ wishes are to be met. The large number of refusals (17 out of 58) may have implications in the planning of RCTs, in that sufficient time needs to be allocated for recruitment.