Osteoarthritis is a condition caused by the progressive degeneration of articular cartilage. It significantly affects patients’ daily activities and degrades the quality of their life due to pain and limitation of hip joint motion.
Total joint arthroplasty is the surgical replacement of damaged articular surfaces by a new artificial joint. This type of surgical procedure is recommended in final stages of the disease (severe advanced arthritis). It is also advised when the effective conservative treatment has failed. This is an absolutely successful and safe procedure. In the recent years, great efforts have been made to improve patients’ care by decreasing perioperative morbidity and decreasing the length of in-hospital stay (LOS).
The newest surgical techniques are associated with better quality and longevity of materials (implants) in time, the improvement of the postoperative analgesia and also the adoption of new faster recovery protocols.
The treatment concept called “fast-track” is based on the cooperation of a therapeutic group, including the orthopedic surgeon, the anesthesiologist and physiotherapist, who work together during all aspects of treatment, anesthesia, postoperative care, pain management, rehabilitation, etc. The ultimate goal is to reduce the need for hospitalization to a maximum of 2 days while maintaining a very high patient satisfaction and very few complications.
The clinical features of the Fast Track protocol for Joint Replacement Surgery, include both intraoperative and postoperative measures. Specifically, patients who are about to undergo hip replacement surgery:
- Get informed accurately for surgery
- Learn what to expect during the postoperative period
- Are taught how to avoid potential risks
- Get trained on how to improve their fitness and joint range of motion as well as their muscle strengthening, preoperatively
- Adopt special nutrition diets
What happens from the Surgical point of view?
- Bloodless application of Minimally Invasive Surgical techniques (MIS) that pays special attention to avoid injury of soft tissue during surgery
- Attempting personalized surgical treatment adapted to the needs and particularities of the problem of each patient
What happens from the Anesthesiologists point of view?
- Assessment and scaling of the perioperative pain
- Proper modification of intraoperative and postoperative analgesia
- Use of newer drugs and anesthetic techniques that contribute to a high level of analgesia and patient's ability to mobilize immediately after surgery
The fast track protocols after total hip arthroplasty are widely used in the US but also in many countries in Europe and combine excellent clinical results, rapid functional recovery of patients and shorter hospital stays. The application of such therapeutic accelerated rehabilitation protocols must be adapted to each health system.
*Dr. Vasileios Sakellariou, MD, PhD was trained in the United States of America (Hospital for Special Surgery, New York) on the Minimally Invasive Techniques (MIS) of the hip, the micro-arthroplasty and the application of Fast Track recovery protocols.
Vasileios I. Sakellariou MD, MSc, PhD
Attending Orthopedic Surgeon
Chief of the Hip & Knee Unit
Mediterraneo Hospital, Athens, Greece