The advantages of day surgery knee replacement

30 March 2022

An x-ray of two knees

Knee replacements were first performed in the UK in the 1970s. Since then, they have evolved and improved, to the point where we can now offer day surgery options. There are approximately 160,000 total hip and knee replacements performed each year in England and Wales1. Longer life expectancy, as well as changes in lifestyle, have resulted in an increase in osteoarthritis. Osteoarthritis is the leading cause of pain2, which can lead to the need for total knee or hip replacement surgery. Osteoarthritis is the most common joint disease worldwide, affecting an estimated 10% of men and 18% of women over 60 years of age3.

What are the advantages of day surgery in knee replacement?

One of the latest improvements in knee replacement surgery has been the introduction of day surgery options. This means that a patient is discharged from hospital within 23 hours of surgery and at Practice Plus Group hospitals, they are usually discharged the same day. There are some advantages to this – for both the patient, and the health system. In 2019, 66% of surgical admissions within NHS England were being undertaken as day cases4. The benefits of day surgery include:

  • Fewer complications – because you are on the move quicker
  • Faster recovery – due to fewer complications
  • Reduced pressure on the NHS – faster turnaround of patients means using less NHS resource and reducing the backlog of patients waiting for surgery.

Let’s look at these in more detail…

Does day surgery reduce the risks of complications?

If a patient leaves hospital within a day, they will get up and move around in preparation for leaving the hospital. Research has shown that patients who mobilise early, make a quicker recovery and have fewer complications.

Early mobilisation increases blood flow around a patient’s body which decreases the potential risks of blood clots. According to a multicentre observational study on hip and knee surgery5: “in many studies, early mobilization protocols reduced the rate of complications/morbidity (e.g. respiratory decompensation/pneumonias, deep venous thrombosis/pulmonary embolism, urinary tract infections, sepsis or infection).”

How long does it take to recover from knee surgery?

Day surgery means faster recovery due to early mobilisation and less pain and swelling from less complex procedures.

At Practice Plus Group, there is rigorous selection criteria in order for a patient to qualify for a day case knee replacement. More complex cases will usually mean a longer stay in hospital, but there are other reasons why someone might not be selected for day case surgery. Whilst age specifically is not a factor, they need to be in general good health and have sufficient support at home during the recovery period.

A typical recovery time from knee replacement surgery is around six weeks. This is likely to involve using crutches for two to three weeks after the procedure and moving down to a single crutch by week four. By week six most patients are moving independently and are safe to drive.

Reducing pressure on the NHS

Day case treatment also reduce the overheads and staffing resource needed for each patient. If we can do more day cases we can treat more people.

Top level modelling by The Kings Fund shows “by treating more patients as day cases, the NHS had in effect saved around £2 billion”6 between 1998 and 2013. This means more resource can be invested elsewhere in the health system in order to benefit other patients.

Following the pandemic, reports show that the total waiting list for treatment on the NHS has hit a record 6 million7. The positive knock on effect of discharging patients early is that beds become free for other patients. This leads to more patients being seen thus reducing the waitlist for those in need, whether that is privately, or on the NHS.

Ensuring positive outcomes

The key to successful day case surgeries is:

  • Careful selection criteria
  • Ongoing support once the patient is home.

GIRFT8 have been driving change and promoting the benefits of day case surgery in all specialities. The vision is that average length of stay in non-day case joint surgery should be 48 hours. This will achieve better outcomes for our patients. Practice Plus Group are working hard to make this a reality. Our Practice Plus Group Hospital in Ilford currently achieves an average length of stay of 40 hours for all joint replacements.


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Sources

1. Surgeon Profile 
2. NHS conditions – hip replacement
3. CKS Nice – osteoarthritis
4. Getting it right first time – National Day Surgery Delivery Pack PDF 
5. NCBI NLM NIH
6. Kings Fund – Day case surgery 
7. Royal College of Surgeons press release – waiting times 
8. Getting it right first time