1 October, 2020
Dr. Fernández-Valencia performs hip replacement surgery without hospitalisation for the first time in Spain
Hospital Clínic de Barcelona has performed, for the first time in Spain, a hip replacement surgery without the need for hospitalisation. Although in recent years it had been possible to cut the hospitalisation time in half (from 7 days to 3.5 days), the operation had not been possible without hospitalising the patient. The intervention was carried out by Dr. Jenaro Fernández-Valencia, from the Orthopedic Surgery and Traumatology Service and Head of the Hip Section of the Hospital Clínic de Barcelona and barnaclínic+. The patient was operated on more than 2 months ago (on July 7th) and has not presented any complications.
“We have managed to get a hip replacement patient to go home the same day as the operation. This procedure is called outpatient hip replacement or hip replacement without admission”
HIP PROSTHESIS SURGERY WITHOUT admission: SAFE AND WITH proven RESULTS
Non-admission hip replacement surgery is a safe technique for the patient and offers effective results. Despite the fact that Dr. Jenaro Fernández-Valencia‘s team has performed this technique for the first time in Spain, it can already be found in other European countries. In addition, the safety and efficacy for the patient is supported by multiple scientific studies. However, it is important to select the candidates properly. The ideal profile for a safe and successful hip replacement surgery without admission is a young patient without serious diseases.
The safety and efficacy of hip replacement surgery without admission for the patient is supported by multiple scientific studies
WHEN WILL THE PATIENT BE DISCHARGED AND WHEN WILL THEy CONTINUE being admitted?
After conventional hip replacement surgery, patients are discharged according to functional discharge criteria; controlled pain, mild pain when walking, the ability to walk about 50 metres and to go up and down stairs, among others, are taken into account. In the case of hip replacement surgery without admission, these functional discharge criterion are maintained. Therefore, if the patient presents insecurity, pronounced pain or does not meet the criteria indicated, they will be admitted until the functional discharge criteria is met.
“Hip replacement without admission represents a paradigm shift in the post-operative management of hip autoplasties. Being able to discharge the patient on the same day of the intervention is another step in the evolution of our rapid recovery program for hip replacement”
HOW DO WE ACHIEVE THE REDUCTION OF HOSPITALISATION IN HIP PROSTHESIS SURGERY?
Patient Training
Before the hip replacement surgery, the patient participates in a workshop to learn about the environment, the pathology, the admission process, the hip operation, functional recovery and what measures to take for a better recovery.
Minimise Blood Transfusions
To avoid possible anemias, which would increase the risk of transfusion, a previous study of the patient is done. In addition, tranexamic acid is administered during surgery. Thanks to these measures, the number of transfusions has been reduced (from 30% in 2013 to only 2% today).
Less Invasive Surgery
The Orthopedic Surgery and Traumatology Service of the Clínic, led by Dr. Pere Torner, has a team specialised in planning and performing minimally invasive hip replacement surgery. Since 2016, Dr. Fernández-Valencia‘s team has been working on the previous direct access technique. This type of procedure allows the prosthesis to be implanted without cutting muscles or tendons, which results in a quick recovery.
Improvement in, and reduction of, post-operative pain
By minimising the use of morphine derivatives and, with a single dose of corticosteroids at the beginning of hip replacement surgery, subsequent pain, nausea and dizziness can be reduced when standing up.
Early mobilisation
To achieve a speedy recovery after hip replacement surgery, it is very important that the patient begins to move. It is the key to improving pain control, muscle and bloodflow.
WHAT DOES HIP PROSTHESIS SURGERY CONSIST OF?
Total hip replacement is intended to replace the deteriorated hip joint. This joint deterioration can be caused by osteoarthritis, by the sequela of trauma, advanced disorders such as dysplasia or by vascular necrosis of the femoral head. Hip replacement surgery usually takes about an hour and a half. It consists of replacing the cavity of the pelvis (acetabulum) with a bowl. This bowl will house the sphere that, linked to a stem located inside the femur, replaces its worn head. The bowl and the sphere can be fixed to the bone, thanks to their material and design, or, if necessary, by means of a special adhesive.