By: 26 January 2023
London’s Chase Farm Hospital pioneers new approach to hip and knee surgery

A patient who was able to go home within hours of having a knee replacement has praised the ‘fantastic’ team that have pioneered a new approached to orthopaedic surgery at Chase Farm Hospital.

Cheng Ong, 62, from Borehamwood, Hertfordshire, is one of a growing number of patients at Chase Farm Hospital who are going home the same day as their hip and knee replacement surgeries. And following her successful treatment, Cheng is now planning a trip to Singapore to see family.

Experts say that treating knee and hip replacements as day cases means fewer complications like blood clots and aids recovery by encouraging patients to get moving sooner.

Cheng who has now had both of knees replaced via a day surgery procedure, said: “When I had my pre-op consultation I was told I was a good candidate to go home the same day. I was shocked and queried it but they reassured me and I really liked the idea. I had the first operation on my right knee towards the end of August and as soon as I got to the ward afterwards the therapist did all the tests to make sure I was ready to go home. Armed with my pain medication and my exercises I felt ready to go and my daughter collected me after she finished work.”

Instead of a general anaesthetic, most of the patients prefer spinal anaesthetic, sedation if they wish and regional anaesthesia (blocking selective nerves that can cause pain) to aid in early mobilisation, which means they are well enough to go home the same day after their therapy goals are achieved.

Paddy Subramanian, consultant orthopaedic surgeon, said: “Patients love it. We had a lady in recently who had the operation on Friday and told us she was in her garden and the hairdressers the following day. It’s a change in mindset for patients and staff that these are not sick nor unwell patients and they are coming in for a joint replacement procedure analogous to a tyre change rather than a complete new engine.”

Ursula Knight, an advanced nurse practitioner in elective orthopaedics, said: “We know patients recover better in their own homes because they actually have to walk a bit more to reach their bathroom or the TV and that reduces the risk of complications. The key thing is that we discharge patients when it is safe for them to go.

“We check the patient’s vital signs, take an x-ray and they are seen by a member of the therapy team before they are given the OK to go home. We also ensure we send them home with the same level of pain management as they would receive if they stayed in hospital. We give then a follow-up call within 24 hours after they’ve been discharged and everyone goes home with our contact details.

“Patients tell us nothing beats waking up in your own bed.”

Mr Subramanian praised the multidisciplinary team (pictured below) for being able to offer this new approach for individual patients. He said: “This is a team effort across the board from pharmacy, the nursing team, therapists, surgeons and anaesthetists. The staff at Chase Farm Hospital have embraced this new way of working and see the benefits.”

Dr Sagar Tiwatane, consultant anaesthetist, said: “Newer anaesthetic approaches, surgical techniques and better collaboration between healthcare professionals are the key factors enabling us to offer day case joint surgeries.

“We know that being able to offer day case surgery adds to the patient experience and the best feedback we have received from the patients is that when they come back in for the same operation on another limb they have requested to go back home again on the same day.”

Deborah Brown, clinical lead therapist for elective orthopaedics at Chase Farm Hospital, said: “It starts from the pre-operative assessment so that these patients are aware of what might take place. After the operation we complete all the therapy, including ensuring they can get in and out of bed, up and down stairs and go to the toilet.

“Like any of our patients they can be apprehensive but as soon as they are up and the pain is under control their confidence builds and once they are walking their independence returns.”

Cheng added: “It went so well that I had my second knee op at the end of October. I’d had to give up work a while ago because I couldn’t walk and was in a lot of pain but now I’m planning a trip back to Singapore to see family and am thinking about looking for part-time work when I come back. I was determined to help myself so I followed all the instructions and the team were absolutely fantastic.”


Source: NHS Royal Free London newsroom

Image: Cheng Ong and elective team. Credit: NHS Royal Free London