Same-Day Surgery and Discharge for Hip and Knee Replacement and Revision

Hip and knee replacement surgeries are among the most successful procedures performed in our healthcare system. The National Orthopaedic Hospital Cappagh performed approximately 1700 of these in 2024, with an approximate 50-50 split between hip and knee replacements. Joint replacement surgery gives our patients unparalleled improvement in pain relief, quality-of-life, and function. The risk of major complications, such as dislocation, infection, or fracture, is low. The success of this surgery depends on the multidisciplinary input of our surgeons, anaesthetists, specialised nursing staff, and physiotherapists, among others.

Since 2018, we have employed a same-day discharge/outpatient joint replacement programme. This was initially driven by Mr James Cashman, a consultant orthopaedic surgeon, and Dr Brid McGrath, a consultant anaesthetist. At inception, this was in a very select group of patients with minimal comorbidities. Since that time, we have been able to develop the programme so that same-day discharge is possible for up to 50% of our patients. This allows patients to return to the comfort of their own homes, with excellent pain relief, having met all their physiotherapy discharge goals, while receiving strong support from our specialised nursing staff. This also results in a shorter length of stay, thus freeing up an inpatient bed for further patients to benefit from care within our Hospital.

In 2024, the average length of stay for a hip replacement was 2.7 days. The average length of stay for a knee replacement was 3.4 days. Patients undergoing same-day discharge are typically admitted at 7 AM and are ready for discharge within 12 hours. In 2024, two surgeons performed same-day discharge for total hip replacements, and two surgeons offered same-day discharge for total knee replacements and unicompartmental knee replacements. A total of 69 patients underwent same-day discharge for hip, knee, and unicompartmental knee replacement. The age range of patients was 32-76 years. No patient required readmission. Two further patients were admitted with a plan for day-case admission but were discharged the next morning, resulting in a 24-hour length of stay. The geographic spread of patients was from Dublin to Limerick and Wexford, and as far as Donegal. In terms of complications, there was 1 dislocation in a hip replacement, which did not require any further intervention. There was one superficial wound infection in a knee replacement, which was treated with antibiotics. Both patients had an otherwise uneventful recovery and had a successful outcome from the surgery.

Since the introduction of this programme, over 300 patients have successfully had their joint replacement as an outpatient. This would not have been possible without the buy-in from all stakeholders within the Hospital, including but not limited to: our arthroplasty nurse specialist, Saibh Canavan, our physiotherapy team, the pharmacy department, and occupational therapy. The success of this programme is a multidisciplinary achievement. Going forward, we hope to build on these successes, with more of our surgeons adopting this approach, hopefully to the benefit of our patients.