Aim: To evaluate the possible increase to surgical/operating room capacity by increasing the percentage of uncemented total hip replacement

Introduction: Globally there is growing demand for increased efficiency and productivity from medical care. In hip arthroplasty there has been increased interest in the use of uncemented components with several studies and registry data showing them to perform well clinically 1, 2. One concern with their increased use has been increased costs 3. We have examined the issue of operative timing and discuss the possible role these components may have in increasing theatre utilisation times and so offsetting their cost.

Methods: This was a prospective, cohort study of every hip replacement performed in a dedicated arthroplasty unit within a district general hospital over one year. All care of patients was standardised using pathways, including all surgeons using a posterior approach with posterior repair. This allowed us to determine the relative effect of prosthesis type on quality, safety and efficiency. Demographic, anaesthetic, operative and timing details on all cases performed were collected prospectively and independently of the surgical team. Patients were reviewed at six weeks and one year post op. All readmissions to any hospital were noted and any further surgery recorded.

Results: There were 1248 cases performed in one year. Of these 194 were uncemented (both components) and 286 cemented total hip replacements. Patient demographics were similar (mean age 70.9 years, range 28–92). Both hip types showed no difference in quality or safety factors as assessed by hip scores, patient mobilisation times, complication rates or revision rates. The only difference was in the surgical times. These were (in minutes):

– Mean Standard Deviation Minimum Maximum

(*p< 0.0005)

Conclusions: Our data demonstrates an average time saving of 17 minutes per case performed. If, over the next year, we converted to all uncemented hips we would release 136 hours of operative time, giving an opportunity to get 100 more cases done. This represents a 20% increase in productivity with no compromise to safety or quality.

Summary: This study of 1000 patients demonstrates how you can dramatically reduce hospital length of stay, improve clinical outcomes, and increase patient satisfaction if a patient-centred pathway approach is adopted.

Introduction: This study evaluates the effect of adopting a patient-centred approach on clinical outcomes, patient satisfaction and operational efficiency. By adopting standardised working practices, dramatic changes can be achieved to reduce patient length of stay (LOS) and consequently surgical capacity.

Methods: We prospectively studied the first 1000 patients who followed the new pathway (549 Total Knee Replacements, 20 Unicondylar Knee Replacements, 384 Total Hip Replacements and 47 Hip resurfacings). The pathway included an enhanced pre-assessment process. Admission dates were mutually agreed and a predicted discharge date of 4 days was provided. All patients attended a pre-operative education session. Patients were admitted on the day of surgery and followed an intensive physiotherapy program. The surgeons, surgical techniques, and discharge criteria all remained unchanged.

Results: The average length of stay was 4.1 days (St Dev 1.8). 80% of patients went home on or before day 4 post-operatively. This was accompanied by a decreased re-admission rate (1.8%), low complication rates for both hip replacement (Dislocation rate = 0.93%) and knee replacement (Knee MUA = 0.87%) and no cases of deep infection. Pre-operative patient reported outcome measures (WOMAC, SF-12 and Oxford) all improved post-operatively (P< 0.0001) and qualitative data from patients was extremely positive towards the new pathway.

Discussion: The decrease in LOS was dramatic and highly clinically significant. The mean LOS for patients prior to commencing this new pathway was 7.5 days (St Dev 5.7). High patient satisfaction rates indicate that by adopting a patient-centred approach, significant decreases to LOS can be achieved alongside improving the quality of care with a low complication and readmission rate.