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NHS Fife offers patients hip replacement day surgery

NHS Fife has become the first health board in Scotland to perform hip replacements in day surgery.

The procedure is only suitable for about 15% of patients but can speed up recovery and free up hospital beds.

Following a method developed in Denmark, staff can have patients back on their feet just hours after the operation.

Doctors hope the new treatment will eventually be rolled out across the country.

Ten years ago, the average stay in hospital for a hip replacement was eight days, now it is four days.

This month, surgeons based at the Victoria Hospital in Kirkcaldy started offering day surgery for suitable patients – those who are generally fitter and have a good body mass index (BMI).

One of the first patients to have the procedure was 50-year-old self-employed roofer David McCallion.

He had bad arthritis in his hip joint and had been putting off getting his right hip replaced but it became too painful.

“It does restrict me and it’s getting worse because I’m a roofer. I’m physical, I’m up and down, and I need to take more painkillers all the time to keep me going so hopefully that will stop,” he said ahead of the operation.

“Walking is harder. I can’t walk any distances because it’s sore. Hopefully this will change that.”

On the day of his surgery Mr McCallion arrived at the hospital just after 07:00 and by 09:30 he was in theatre.

Edward Dunstan, director of surgery for NHS Fife, carries out an average of four joint replacements a day.

He explained how the new procedure works: “Normally, when you have a spinal anaesthetic the legs are completely numb and they don’t work for four to six hours afterwards.

“All we are doing here is numbing the capsule, the tendons, the ligaments around the hip to take the pain away from the hip joint itself but that means the muscles are still working so the patient can walk straight afterwards.”

The operation itself is routine and takes less than an hour but it is the recovery time that should be improved using the new procedure.

“It makes a huge difference for the patient,” said Mr Dunstan.

“It increases functional recovery so they get back to driving quicker, get back to work quicker. It reduces muscle loss in the body, if you stay in bed too long you lose muscle mass. It increases the oxygen saturation in the blood which makes them feel very much better.

“It also increases patient satisfaction rate and, importantly, it reduces the risk of clots which can be a dangerous complication of hip replacement surgery.”

Across Scotland there are about 15,000 major joint replacements carried out each year – the average cost of each surgery is about £5,500.

Mr Dunstan said the ability to offer day surgery meant a saving for the hospital too.

“When you consider a one night stay in hospital is £500, if you can reduce that by just two days you are saving £1,000 of that patient episode,” he said.

“The average cost of a hip replacement is probably about £5,000 – £6000 so certainly by reducing length of stay in an appropriate, supportive fashion, yes we can make savings.”

By 18:30 on the day of the operation, Mr McCallion’s new hip had been checked using X-rays to make sure the joint looked okay, before he was discharged.

The father of two boys had initially been told he would need about 12 weeks off work to recover from a hip operation, but he was hoping the new procedure, which he described as great, would speed that up to about 10 weeks.

“I prefer [this procedure] than having to stay in hospital all night. The kids will be more settled and I’ll be more settled at home.”

His wife Debbie added: ” I was amazed at the time it took him to come from being in the operating theatre to sitting here. It was virtually within an hour he was up.

“He’s done really well.”

The NHS Fife project is a pilot, with NHS Greater Glasgow and Clyde also trialling half knee replacements in a day.

The hope is that such treatments will eventually be rolled out across Scotland.

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BBC News – Health

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