Fast-Track Arthroplasty: What You Need to Know

Who are suitable candidates for fast-track arthroplasty

Fast-track arthroplasty is successfully performed in patients who require total knee or hip arthroplasty. These patients usually have advanced-stage osteoarthritis or other forms of arthritis, such as rheumatoid or post-traumatic arthritis.

Advantages of fast-track arthroplasty

The advantages of fast-track arthroplasty compared with traditional techniques are numerous. Patients usually have a shorter hospital stay, less pain and a reduced risk of complications. They also return to their daily activities more quickly.

Some of the specific advantages of fast-track arthroplasty include:

• Shorter hospital stay: Patients undergoing fast-track protocols usually remain in hospital for 24 hours, compared with 3-4 days for patients undergoing traditional arthroplasty.
• Less pain: The local anaesthesia used in fast-track arthroplasty provides very good pain control after surgery. Patients usually do not require strong painkillers and can be mobilised immediately. In addition to spinal anaesthesia, the specialised anaesthesiologist also performs a nerve block of the knee – a technique that eliminates immediate postoperative pain. The minimally invasive surgical technique limits tissue injury during the operation and therefore leads to reduced postoperative pain.
• Reduced risk of complications: The rapid recovery protocol has a lower risk of complications than traditional arthroplasty. This is because patients are mobilised earlier, which helps prevent thrombosis, pulmonary infections and other complications. Blood transfusion is also rarely required, as the minimally invasive technique combined with the administration of specific medication (tranexamic acid) minimises blood loss during surgery.
• Rapid return to daily activities: Patients undergoing fast-track arthroplasty can usually return to their daily activities relatively quickly. Full weight-bearing is encouraged from the first postoperative hours. Initially, walking support (walker or crutches) is used for a few days so that the patient feels safe.

Summary of the benefits of fast-track arthroplasty

• Small incision – excellent aesthetic result, with less tissue trauma
• Shorter hospital stay – 24-hour hospitalisation
• Reduced postoperative pain
• Bloodless surgery (no transfusion required)
• No urinary catheter or analgesia devices
• Fewer intraoperative or postoperative complications
• Immediate mobilisation of the operated leg on the same day – a few hours after surgery
• Preventive use of support (crutches or walker) only to make the patient feel safer
• Faster recovery and return to daily life

Preparation for arthroplasty

The patient will be informed about the proposed surgical treatment with arthroplasty. The anaesthesiologist will examine the patient, take a detailed medical history and organise the preoperative assessment. The preoperative assessment includes routine blood tests, a chest X-ray and a cardiological evaluation. The anaesthesiologist will provide the necessary instructions regarding whether or not to take medications before surgery, as well as when the patient should begin fasting.

The role of the surgeon’s experience

Fast-track protocols require specialised expertise from both the surgeon and the anaesthesiologist, as well as organised hospital facilities with comprehensive and modern medical equipment. Mr Leonidou, following 14 years of continuous practice in the United Kingdom, is fully specialised and certified in minimally invasive techniques and rapid recovery protocols. Our anaesthesiologist specialises in fast-track – enhanced recovery protocols for the safe and pain-free performance of arthroplasty. It is important to note that the patient does not receive general anaesthesia, but only regional anaesthesia. Special anaesthetic and surgical techniques help limit bleeding, eliminate postoperative pain and reduce potential complications following a total knee arthroplasty procedure or hip arthroplasty procedure.

Application in shoulder arthroplasty

Fast-track rapid recovery protocols are also used by Mr Leonidou in shoulder arthroplasty (total or reverse). More specifically, the surgical approach is performed on the lateral surface of the shoulder (rather than from the front, as is traditionally done). As a result, the incision is small and the underlying tissues are not injured. In addition, the Verso minimally invasive arthroplasty system is used – without a stem or cement. Finally, the anaesthesiologist performs an interscalene block – regional anaesthesia under ultrasound guidance, eliminating immediate postoperative pain. As a result of these techniques, patients undergoing shoulder arthroplasty experience the following benefits:

• Reduced postoperative pain – without analgesia devices or strong painkillers
• Smaller incision with an excellent aesthetic result
• 24-hour hospitalisation
• Bloodless surgery – no transfusion required
• Immediate mobilisation of the shoulder within a few days – rapid recovery protocol. It is important to note that the arm remains supported in a sling for only a few days and not for several weeks, as with traditional techniques.
• With the specialised anterior deltoid strengthening protocol, arm movements recover quickly and the patient rapidly regains their quality of life and returns to daily activities.