Rapid recovery following hip and knee arthroplasty using local infiltration analgesia: length of stay, rehabilitation protocol and cost savings

Abstract

Background We implemented local infiltration analgesia (LIA) as a technique of providing post‐operative pain management and early mobilization after arthroplasty surgery and have progressively found patients able to go home earlier. This study compares the national data on hip and knee arthroplasty provided by the Royal Australasian College of Surgeons and Medibank Private with our outcomes using LIA and rapid recovery. Methods Prospective study of one surgeon including 200 knees, and 165 hips in the two years till June 2016. Variables included in comparison to the two groups were: length of stay, percentage of patients transferred to rehabilitation or intensive care unit (ICU), readmitted within 30 days and average separation cost. Results Hip replacement median length of stay in our series was two nights versus five nights, inpatient rehabilitation 7% versus 36%, ICU admission zero versus 4%, and readmissions 3.9% versus 6.0%, the average hospital separation cost in our series was $17 813 versus $26 734. Knee replacement median length of stay in our study was one night versus five nights, ICU 0.5% versus 3%, rehabilitation 4.5% versus 43%, and readmission 6% versus 7%, the average hospital separation cost in our group was $16 437 versus $27 505. Conclusion The comprehensive approach of LIA and rapid recovery enables patients to have shorter hospitalization, lower rehabilitation incidence and a resultant reduction in health expenditure.

Intervention Effect of Rapid Rehabilitation Nursing Combined with Continuous Nursing after Discharge on Patients with Cerebral Infarction in Recovery Period and the Changes in Motor Function, Mental State, and Quality of Life

“…Rapid rehabilitation nursing is a new nursing concept emerging in recent years. Professional nursing and rehabilitation guidance can reduce the trauma stress of patients, shorten the hospitalization time, and promote the early recovery of patients' body function [5]. Rapid rehabilitation nursing is scientific, rapid, and comprehensive, which can optimize many nursing measures during hospitalization, thus reducing stress response caused by diseases, and has played a key role in cancer, urology, and gastrointestinal and other diseases [6].…”

Impacts of the perioperative fast track surgery concept on the physical and psychological rehabilitation of total hip arthroplasty

“…[ 15 ] Finally, we encouraged patients to get out of bed and exercise early after surgery, which can promote rapid recovery and prevent complications such as infection. In a prospective study, Nasser et al [ 16 ] included 220 patients with knee replacement and 165 patients with hip replacement. He found that patients who were treated with the rapid rehabilitation approach had less pain after surgery, shorter hospital stays, and lower hospital costs.…”

Fast Track Arthroplasty Using Local Infiltration Analgesia

“…According to a study conducted in Ballarat, Victoria in 2020, they used a LIA cocktail derived from Kerr's protocol. Their mixture consisted of 350 mg of ropivacaine, 30 mg ketorolac, 4 mg dexamethasone and 0.5 mg adrenaline [14]. The catheter top-up was injected in the morning post-operative with dose of 20 mL including 100 mg ropivacaine, 4 mg dexamethasone, 30 mg ketorolac, 0.5 mg adrenaline (adrenaline given for total hip arthroplasty (THA) only and not total knee arthroplasty (TKA)) and normal saline.…”

“…The use of fast track or rapid recovery arthroplasty has been successfully implemented within multiple health systems in many different countries globally over the past 10-15 years [14,[39][40][41][42][43]. To successfully implement fast track arthroplasty, the care pathway involved is complex and multidisciplinary.…”