Barry Oldham, 68, from Clun, Shropshire recently had his right knee replaced and just 20 minutes after leaving the operation theatre he was in the recovery room doing leg raises. Oldham later started using crutches going to and from the bathroom. He was able to go back to his own home within 48 hours. This may sound like a cost-cutting measure by the hospital but it was down to a new approach, known as rapid rehabilitation. Each year in the UK there are known to be up to 70,000 knee replacement procedures performed. These involve the patient being treated with nerve blocks – injections of local anaesthetic at the top of the leg – and then a general anaesthetic.
The blocks paralyse the nerves, which prevent the pain after surgery, but are unable to use their leg muscles up to 36 hours when the effects wear off. The general anaesthetic generally makes the patient feel nauseous afterwards. It’s also worrying being immobile for a while puts patients at increased risk of developing Deep Vein Thrombosis (DVT) a very common side effect proceeding knee replacement surgery.
With rapid rehabilitation, neither general anaesthetic nor nerve blocks are used. The alternative technique is called local infiltration anaesthesia, developed in Sydney, Australia – this involves a large dose of anaesthetic solution injecting into the tissue surrounding the knee joint before, during and at the end of surgery. The treatment also includes mild sedation anaesthesia, similar to an epidural. This enables the patient to start moving their legs shortly after like Barry Oldham could.
This rapid replacement means patients can leave hospital within 48 to 72 hours, but up to 5 percent leave within 24 hours. ‘I passed the beds of men who had conventional knee surgery and got chatting. They couldn’t believe I had my op the previous night. This made me realise how lucky I was to have been on the rapid recovery programme.’
Twelve days later Barry, a retired deputy headmaster, dumped his crutches and was driving his car. Things also dramatically improved for Barry on the 17th day, for the first time in ages, he walked a mile from the car park at Carding Mill Valley to the tea room and back.