Rehabilitation implications during the development of the Norwich Enhanced Recovery Programme (NERP) for patients following total knee and total hip arthroplasty

Background/hypothesis: To report the analysis of the initial rehabilitation results of the Norwich Enhanced Recovery Programme (NERP), regime with increased post-operative physiotherapy input following total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed under spinal anaesthetic with wound catheter infiltration.

Materials and methods: A secondary analysis of a service improvement programme was undertaken from an acute National Health Service Hospital in the United Kingdom. Ninety-five patients listed for THA (n=67) or TKA (n=28) were reviewed during the first six post-operative weeks. All received an enhanced post-operative programme including commencement of mobilisation four hours post-operatively and physiotherapy interventions a minimum of twice daily during hospital admission. The primary outcome measure was the Iowa Level of Assistance Score at discharge. Secondary outcomes included length of hospital stay (LOS), visual analogue scale pain at discharge and complications during the initial six post-operative weeks.

Results: The NERP is a successful rehabilitation regime for patients following THA and TKA, facilitating early safe discharge (mean LOS=3.5 days) with minimal complications. Patients who commenced mobilisation on the day of the operation reported significantly reduced pain score (p=0.02) and length of stay (p<0.01) compared to those who did not. Thirty-four percent of patients were discharged with rollator frames.

Conclusions: Whilst the early results of the NERP allow patients who have undergone THA or TKA surgery a short hospital length of stay, its demand on out-reach physiotherapy suggests that the availability of such community services is imperative to ensure the appropriate progression of rehabilitation.

Level of evidence: Level IV - retrospective series.