An advanced approach to shoulder replacement surgery is giving patients at Barlborough NHS Treatment Centre the opportunity to be operated on and sent home in a single day.
The procedure ensures the growing numbers of otherwise fit people needing shoulder replacement surgery receive the best quality treatment while enabling them to recover at home. This reduces treatment times and the need for overnight stays, freeing up resources for other patients and minimising the risk of acquiring subsequent infections.
Dr Marco La Malfa, medical director and consultant anaesthetist at Care UK’s Barlborough NHS Treatment Centre, said: “Shoulder surgery has had a notorious reputation for substantial pain afterwards. For patients who commit to playing their own part in preparing for the operation, and their recovery, this procedure offers a really promising approach.”
However the surgery isn’t suitable for everyone. Patients undergoing the day-surgery pathway need to have good overall health and fitness with no other medical or weight issues. They also need to have sufficient support at home to ensure they can be cared for after the operation.
Dr La Malfa believes the key to the success of this approach is a candid discussion with the patient about maintaining or building fitness levels before the operation and committing to a programme of physiotherapy afterwards. In the days before the operation, physiotherapists work with patients to familiarise them with their post-operation exercise regimen.
He said: “The day of the operation begins early, so the patient has maximum time to recover before being discharged later in the day. The operation is performed under regional rather than general anaesthetic, which can last for up to 22 hours, and is performed using minimally invasive techniques; reducing potential blood loss.”
A registered nurse, or the operating surgeon, maintains close contact on the day of the operation and keeps in touch when the patient returns home. The consultant anaesthetist remains on call throughout the night and speaks with the patient the next morning to check on recovery. The patient then returns to the treatment centre within the following week for a physiotherapy review.
Patients receiving the treatment say they feel well-supported and comfortable, needing only conventional painkillers after the operation and reporting daily improvements in their shoulder recovery.
One patient to benefit is great grandmother Hilda Buxton from Doncaster who, following two shoulder operations, is back knitting and enjoying life pain-free.
Hilda endured years of pain from the osteoarthritis in her shoulders. No stranger to pain, as she had a hip replaced 11 years ago because of the same condition, she struggled on until her life became severely restricted.
She said: “I couldn’t put my hands above my head. Drying my hair and putting things away in the kitchen cupboard became very difficult. I even had to give up knitting, which I have done all my life. The pain also meant that I struggled to sleep, as I couldn’t find a comfortable position, and being tired just made me feel worse.”
Hilda’s GP asked her if she wanted to be treated at Barlborough NHS Treatment Centre, where she had her hip replaced: “I said yes, definitely. I was so impressed with the centre. Everyone is friendly, caring and professional. It is spotless and the food is very good.
But Hilda didn’t get to stay very long to enjoy the food as her surgical team performed the joint replacement in her left shoulder in just one day: “I was amazed. I went down for the operation at 8am and I left the hospital at 6pm. It was wonderful and I felt no pain.
“The procedure was carried out using a regional block rather than a general anaesthetic. The team chatted away to me and I was perfectly calm and happy. I was also surprised at the lack of pain after the operation and, no matter how nice a hospital is, it’s always nicer to be in your own bed.”
Once Hilda had fully recuperated she returned for a replacement joint in her right shoulder and the procedure went just as well: “It is marvellous. I have been able to get back to knitting and painting and being pain-free is a joy. I am very grateful to the team. I wouldn’t go anywhere else and I would recommend them to anyone needing NHS treatment.”
Surgeon Ford Qureshi said: “I am delighted to hear Hilda is once again enjoying life. We aim to give people the range of movement that enables them to live their life and enjoy their interests pain-free.
“The techniques we use mean that patients do not have to undergo a general anaesthetic, which can leave them feeling nauseous, dizzy and confused. Using a local anaesthetic can also mean they are able to go home on the same day and we work with them to monitor their levels of pain and wellbeing after they are discharged.”
Dr La Malfa added: “More than 4,000 shoulder replacement surgeries are performed in the UK every year with most of the patients between 65 and 74 years of age. For those people who look after their health and can commit to playing their part in preparing themselves for the treatment, this procedure presents a life-changing opportunity.”