Enhanced Recovery Programme

K J DrabuConsultant Orthopaedic Surgeon

AimImprove patient care and experience

Good analgesiaMinimal GI problems

Minimal complications (Surgical & General)Early dischargeGood mobility

Where does it start and where does it go?

PatientGPPre-assessment – Physio and nurseSurgeon/AnaesthetistWard staffPatient

PhilosophyPositive approach from the startPatient and home support team pre-preparedClear understanding of the whole processEmphasis on early and safe mobilityEncourage the patient to “lead”

Patient

Aware and requesting the procedureWord of mouth and mediaDefined admission date and defined discharge

dateHome support in place when needed

GP

Aware of the processPre-prepares patient for process – Co-

morbidities, smoking, bowels etcPre-prepares home supportNOT RAPID DISCHARGE

Pre-assessment – Physio and Nurse input

Positive approach Point of contact for patientDeal with any issues – Pain, smoking, bowels etcPrepare for appropriate mobilityPre-op exercise programme

AnaestheticSingle shot spinalPropofolTranexamic acid and intra-operative re-

transfusionIV AbxOndansetronIV Fluids to 1 Lit intra-op

Operative TechniqueStandard procedure

A/lat approach, supine

Mini-incision

Preservation of Glut Medius

Obese patients

Posterior approach

TO DRAIN OR NOT TO DRAIN??

Mini Incision

2 cms greater than cup10 cms or lessMinimal disturbance to soft tissuesBerger – Chicago (Dual incision)AMIS

Mini- Incision THRsAdvantages

Less soft tissue disruptionQuicker rehabilitationLess blood loss

DisadvantagesLess visualisationRisk of complications

Indications for Mini Incision THRs

Not overweight patientGood bone“Normal” arthritic hip jointNot bilaterals?95%

Antero-lateral approach

Preserve Glut MediusLeg lengthCup orientationStability

Post-operative (Ward)Early mobilitySelf management – exercise programme and

mobilityCatheter – In/OutAvoid bed pans

THERE IS NO BETTER FEELING THAN FEELING NORMAL

Ward (Physio & Nurse Lead)

Self mobilityPositive feedbackAct quickly where neededRe-assure re point of contactInform Consultant of any problems after

dischargeContact telephone for follow up

Enhanced Recovery

Thanks toJackie Stayton

For leading this project

THANK YOU