All about day-case hip replacements

Hip replacement surgery is a major procedure performed on over 100,000 patients in the UK each year. Be it that may be a major surgery, refinement to the techniques used means that most patients can have their hip replacement conducted as a ‘day case’ – once the surgery is complete and after a few hours of observation and to recover from the anaesthesia, patients can go straight home (with assistance!). In this article, Mr Erden Ali, a consultant orthopaedic surgeon at RNOH Stanmore, talks about the reasons for day-case hip replacements, and what patients can expect.

How do day-case hip replacements differ from normal hip replacements?

In traditional hip replacement surgery, one long incision through the skin and muscles is made near the buttocks. Through this incision, the surgeon is able to expose the deformed bones comprising the hip (the femoral head and the acetabulum). These bones are then reshaped and fitted with the prosthetic pieces. The patient is typically under a general anaesthesia for the duration of the two-hour (or so) procedure, and will spend around two nights to a week in the hospital.

 A key aspect of day-case hip replacement surgery is the minimisation of tissue disruption, which takes up a large part of the recovery process and is what leaves the patient incapacitated for longer. This is achieved by utilising minimally invasive approaches to the surgery, such as robotic assistance, or working around the anatomy, such as an anterior approach procedure. They can be conducted with general anaesthesia, but what is preferred is spinal anaesthesia, which is just as effective and wears off quicker, with patients having the option to be sedated or awake during the procedure.

What are the outcomes of day-case hip replacements?

The significance of reducing tissue disruption in surgery means that there is an overall smaller ‘wound’ that was created during the process, which is faster and easier for the body to recover from. This results in less blood loss, a smaller risk of infection and other complications, smaller scars, a shorter recovery period, and almost immediate mobilisation. It is more beneficial for the patient and their new hip to avoid spending too much time in bed and instead get back to their day-to-day milieu as soon as possible (barring strenuous activities).

Day-case hip replacement patients are also less likely to need readmission.

The treatment doesn’t end once the bandages have been placed; patients have to be able to commit to a customised, post-operative at-home care plan with pain management, physiotherapy, and adjustments to their environment and habits to not aggravate the wound.

Who is suitable for a day-case hip replacement?

Though it may be an appealing option for patients, not all hip replacement patients are suitable – patients with complex anatomy and other health concerns, like obesity or a weak heart, require more specialised care, which means that they need either a more specialised procedure or need to stay longer for observations. The ideal patient is physically fit with no major preexisting conditions and has a support network that can assist at home with things such as transport, bathing, and other accessibility needs.

Before discharge, each patient receives a personalised recovery plan, including exercises and pain management, tailored by our ward team. Patients are only discharged when it's medically safe, and the patient feels confident about starting their recovery journey at home.