Over 200,000 hip and knee replacements are performed in the UK every year. They are usually performed only when conservative treatments such as physiotherapy, weight loss, and medications are no longer effective. The average length of hospital stay for knee or hip replacement surgery is currently 2.7 days.
The NHS guidelines recommend that most hip and knee replacements should be performed as day-cases, meaning patients leave the hospital on the same day as their operation and recover at home. However, fewer than 1% of patients are currently discharged on the day of their surgery.
Potential benefits of leaving the hospital on the day of the operation include faster recovery, reduced infection risk, improved patient experience, and shorter waiting lists for surgery, as hospitals can treat more patients with more beds becoming available. This approach can also create considerable cost savings for the NHS.
To address these challenges, the IDAPO study (Implementation of Day-case Hip and Knee Arthroplasty ensuring Optimal Patient Experience and Outcomes) seeks to understand why hip and knee replacement surgeries aren’t routinely delivered as day-case procedures and to help hospitals implement pathways that benefit patients.
This six-year NIHR Programme Grant of £3.8 million is led by Dr Ines Rombach, a senior medical statistician at the Clinical Trials Research Unit at the University of Sheffield, and Antony Palmer, a clinician scientist and orthopaedic surgeon at Oxford University Hospitals and the University of Oxford.
Palmer says most patients who undergo day-case surgery are pleased with their experience. However, some patients and their support networks express reservations. Not everyone is suitable for day-case surgery for medical or social reasons.
“We have performed day-case surgeries for more than ten years, and they are strongly encouraged by the NHS, yet only a very small portion of patients leave the hospital the same day. There is much to find out about day-case surgery, including patient and clinician views, barriers and facilitators of day-case surgery, and what represents the best clinical care for each individual.”
The study team will review existing research, examine current practices and outcomes of hip and knee joint replacement surgery in the UK, and interview patients, their carers, and healthcare professionals. They will then design a day-case pathway, including training packages and resources for hospital staff and patients.
The new pathway will then be tested in a randomised controlled trial comparing it with the current standard care, which involves a hospital stay of at least one night.
If IDAPO is successful in developing an efficient day-case pathway, the study has the potential to save the NHS £40 million annually.
For more information about IDAPO, please visit the study webpage.