Arthritis & Joint Replacement Clinic
C-21, 4th Floor, Yugadharm Complex,
Opposite ICICI Bank, Near Hotel Centre Point,
Ramdaspeth, Nagpur 10, MS, INDIA
Total Hip Replacement (THR) and total Knee Replacement (TKR) the most successful and most common orthopedic procedures across the world. There have been tremendous and continuous improvements in surgical techniques, pain control, anesthesia, implant designs, surgical materials, longevity, and surgical outcomes after THR and TKR. In next few years number of hip and knee surgeries performed in India will increase manyfold due to huge population suffering with osteoarthritis and excellent surgical outcomes.
Prof. Henrik Kehlet from Denmark proposed Enhanced recovery protocols incorporating surgical stress response, less fasting multimodal analgesia, and fast track surgery in general and gastrointestinal surgery. Enhanced Recovery is especially suited for THR and TKR surgeries as these are high volume procedures, were associated traditionally with longer hospital stay, higher surgical costs and surgical complications. Enhanced Recovery Protocols (ERPs) leads to shorter hospital stay, lower hospital acquired infections, lower complications, faster recovery, early return to work, improved outcomes and lower health care cost burden for the country.
With increasing costs of surgery due to emphasis on quality and standards, expensive implants, strict regulations, numerous healthcare compliances and economic challenges there is a need for audit of surgical costs as well as surgical outcomes. Hospitals will be forced to make optimum use of resources and provide best outcomes. The best way to reduce surgical costs after THR and TKR is by reducing complications and reducing hospital stay and scientific evidence proves Enhanced Recovery Protocols achieve both.
Due to Enhanced Recovery, patients experience less pain as there is less tissue damage due to minimal invasive surgical techniques. There are no tubes, drains or pipes after surgery and patients can resume normal life activities much sooner after surgery. This is important for all ages specially in younger, active, and working patients who want to get back to their jobs early as to reduce time off from work and avoid financial losses. According to scientific evidence, Enhanced Recovery is also associated with minimum bleeding, quicker muscle recovery, higher range of motion and reduced risk of complications.
Our average length of stay after surgery at Nagpur for THR has reduced to 2-3 days after THR and 3-4 days after TKR which is better than reported length of stay data from our country. Patients can start eating and drinking soon after surgery and do not feel weakness. Majority of patients are walking on day of surgery within 3-4 hours after surgery. All patients can independently use toilets and climb stairs within 1-2 days, can safely go home faster and can join their jobs earlier than others. Patients regain range of motion faster and many patients are even able to sit cross legged few weeks after surgery. ERPs have improved long term outcomes and satisfaction after THR and TKR and worldwide.