The recovery pathway that speeds up hip and knee replacements
Replacement Scheduled for hip or knee replacement? The Enhanced Recovery Pathway should soon have you back on your feet and heading for home - but what is it, and how can you help?
You had a hip replacement just hours ago but instead of simply leaving you in bed, physiotherapists are already encouraging you to get back on to your feet.
At first glance this may seem cruel, but in fact getting hip and knee replacement patients moving as soon as possible after surgery is known to promote faster, more successful recovery.
"Getting you back on to your feet quickly has been shown to promote better outcomes, with fewer complications such as deep vein thrombosis and blood clots," says Dr Mike Roddis, Group Medical Director, BMI Healthcare and former medical director of an acute care hospital in the NHS.
The policy of getting joint replacement patients mobile quickly is part of the Enhanced Recovery Pathway (ERP) a Department of Health initiative designed to provide a system of co-ordinated end-to-end care from a multidisciplinary medical team that aims to achieve faster patient recovery.
Department of Health figures show that the introduction of ERP for hip and knee replacement patients has reduced hospital stays from an average of 6 to 7 days in 2008 to 4 days in 2013. A 2011 study showed a 'substantial' reduction in death rates and a reduced requirement for blood transfusions after the introduction of ERP.
The ERP involves a series of prescribed practical procedures but underlying the whole process is the philosophy of patient involvement. "It means the patient understands what will be done by whom and why, and how they can help their own recovery. For instance, when they are helped to their feet soon after a hip replacement, they will understand how it will benefit their recovery," says Roddis. "If patients are given more control over what happens to them there is evidence of improved outcomes."
The ERP starts before patients are admitted to hospital for the operation.
"We initially check your medical notes to check if you have any conditions that could affect your recovery," says Roddis.
Then you will attend a physical pre-assessment to check your current physical condition. "Here your haemoglobin levels will be assessed and if necessary, iron pills will be prescribed to boost your haemoglobin levels. Haemoglobin carries oxygen around the body and so helps with faster healing. It also means that there is less chance of you needing a blood transfusion during an operation," Roddis says.
Patients also receive a pre-operative briefing about the practical steps of the ERP and are encouraged to ask questions about their surgery and rehabilitation. Before the operation they are also taught exercises that strengthen the joint so as to improve the speed of recovery.
"We also talk to patients about analgesia, so it is suited to their personal needs," says Roddis.
Other, perhaps unexpected, steps in the recommended ERP procedure include pre-loading the body with extra energy by giving patients two timed doses of a carbohydrate-rich drink. The clear, flavoured liquid, similar to sports drinks, contains dextrose and fructose, and is absorbed very quickly.
"Having an operation is like running a half-marathon," says Roddis. "You lose fluid, blood and energy and the body enters a catabolic state where it starts to take energy from its reserves, so preloading the body with energy in the form of carb-rich drinks helps speed recovery."
The pathway can vary slightly according to hospital. Roddis says: "We are highly patient centred. For instance if you want to use complementary therapies such as aromatherapy or acupuncture alongside standard pain relief you can - we have physiotherapists who are trained in acupuncture."
After the operation, patients are usually back at home within a few days - in some cases on the day of the operation - provided they are well enough.