Purpose: We report an evolving technique for managing peri-operative pain relief that has enabled early mobilisation and facilitated early discharge after primary Total Knee Arthroplasty (TKA).

Methods and Results: Our organisation has instituted a regime covering all aspects of the peri-operative care for TKA. This includes: pre-operative counselling and preparation; multimodal anaesthesia and analgesia regime; intra-articular analgesia for 24 hours post-operation; early mobilisation regime. We carried out an audit of prospectively collected data of all patients undergoing primary TKA in the six months from January to June 2008 (total of 319 patients), including pain scores, discharge from physiotherapy and follow up data at six weeks.

A total of 305 TKAs with complete data sets were included in the analysis. Of these 36% were mobilised on the day of surgery and 93% by post-operative day 1. Catheterisation rates were 12% and the need for postoperative intra-venous fluids was 10%. In-house physiotherapy discharged 58% of patients by day 3 and 85% by day 5. The visual analogue pain scores (on movement) on day zero and day one were within acceptable limits (median = 3) and 80% of patients experienced no nausea or vomiting.

Functionally, the median range of movement at discharge was 85° with 31% of patients requiring out-patient physiotherapy assessment. At six weeks the median range of motion was 95° with only 5% of patients having a reduced range of motion (reduction of > 10°) when compared to discharge. The median Oxford scores improved from 43 pre-operatively to 26 at six weeks.

Conclusion: This regime offers an efficient method for post-operative pain relief and early mobilisation with the added benefit of reducing post-operative catheterisation, intra-venous fluid requirements and the need for post-operative physiotherapy. It compares very favourably with published data on other peri-operative regimes using regional anaesthesia.

Introduction: We report an evolving technique for managing peri-operative pain relief that has enabled early mobilisation and facilitated early discharge after primary Total Hip Arthroplasty (THA).

Methods: Our organisation has instituted a regime covering all aspects of the peri-operative care for THA. This includes: pre-operative counselling and preparation; multimodal anaesthesia and analgesia regime; intra-articular analgesia for 24 hours post-operation; early mobilisation regime. We carried out an audit of prospectively collected data of all patients undergoing primary THA in the six months from January to June 2008 (total of 138 patients), including pain scores, discharge from physiotherapy and follow up data at six weeks.

Results: A total of 122 THAs with complete data sets were included in the analysis. Of these 27% were mobilised on the day of surgery and 97% by post-operative day 1. Catheterisation rates were 16% and the need for post-operative intra-venous fluids was 15%. In-house physiotherapy discharged 58% of patients by day 3 and 87% by day 5. The visual analogue pain scores (on movement) on day zero and day one were within acceptable limits (medians were 2.5 and 2 respectively) and 84% of patients experienced no nausea or vomiting.

Functionally 14% of patients required out-patient physiotherapy assessment. At three months the median Oxford scores had improved from 43 pre-operatively to 20.

Discussion: This regime offers an efficient method for post-operative pain relief and early mobilisation with the added benefit of reducing post-operative catheterisation, intra-venous fluid requirements and the need for post-operative physiotherapy. It compares very favourably with published data on other peri-operative regimes using regional anaesthesia.