Victoria hospital offers innovative same-day hip and knee replacement surgery

Under the new protocols, patients can leave the hospital a few hours after their operation
Adam van der Zwan · CBC News ·Sep 02, 2020 

The Victoria Enhanced Recovery Arthroplasty program involves injecting anaesthetic into the space outside the spinal fluid, which has drastically improved patient recovery times for hip replacements at Royal Jubilee Hospital in Victoria, B.C. (Submitted by the Vancouver Island Health Authority)

[Excerpts] Seventy-one-year-old Dan Kelly says he was in disbelief when he left the Royal Jubilee Hospital in Victoria three hours after a total hip replacement.
“I did a little jig right after I got off the bed,” he recounted. “I walked about 30 feet to the bathroom. That was just an hour after my surgery. It was unbelievable.”

Kelly is one of eight trial patients who’ve had hip or knee replacement surgery under Island Health’s new Victoria Enhanced Recovery Arthroplasty (VERA) program, over the past year. 

Dr. Duncan Jacks has created a committee to expand the VERA program to other types of surgery at Royal Jubilee Hospital in Victoria in the near future. (Submitted by the Vancouver Island Health Authority)

Lead orthopedic surgeon Dr. Duncan Jacks says hip and knee replacements are in high demand, and the program involves a new way of controlling pain and anesthesia before, during and after surgery, to drastically improve patient recovery. 
Under the new protocols, patients who are “reasonably healthy” are given a number of medications before their operation “to target all the different pain pathways … before the pain sets in,” said Jacks.

Patients are also injected with anesthetic into the epidural space outside the spinal fluid, rather than into the fluid directly, “allowing the patient’s motor-function to recover almost immediately.” 

Jacks said his team is also trying to minimize soft tissue damage through different cutting techniques, and is using specialized sutures and dressing materials to minimize drainage from surgical wounds.

• Wait times for hip and knee replacements grow in Canada

Together, these procedural changes have produced amazing outcomes for patients, Jacks said, adding that they’d traditionally feel nauseous, groggy and dizzy, and would have to stay in the hospital for up to a few days post-operation.

Kelly, who had his first hip replacement using the old method, said his first surgery was painful, he was kept in the hospital overnight, and he wasn’t able to move his leg properly for a couple of weeks. Under the new program, Kelly was told to treat his leg “as normal.” 
“That night, I slept on the side of the hip they operated on. In the morning, I walked out onto my deck, had a coffee, and didn’t even feel like I had an operation,” he said.

Jacks to expand program to other surgeries
In Victoria, Jacks said the new protocols will meet the increasing demand for joint replacements, and will cut costs for the hospital and patients, due to less time spent in recovery.
Jacks says he hopes to expand his program to other types of surgery, and has formed a committee of nurses, pharmacists, physiotherapists and other health professionals, to develop a “fully-fledged, standardized protocol” for Island Health.
He said he’s already performed operations on two more patients this summer, and all 10 patients have left the hospital on the same day as their surgeries, without complications.

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