Hip and knee prostheses fast track

Prosthetic Surgery for joints is carried out with the most advanced computerized devices or the best protocols according to patients’ needs (the so called PSI – Patient Specific Instruments), so that the implant could be personalized and the procedures discussed to be the best suited for patients’ physical and functional characteristics.
 
The fast track in the perioperative assistance context it is meant as a path towards patients aiming at promoting their safety and reducing adverse events (urinary tract catheter and joint drainage, for example) ensuring a pain managing thanks to L.I.A. (local infiltration anaesthesia). As a consequence, patients are able to assume the assisted autonomous walking only 2 or 3 hours after the admission to the ward.
Furthermore, it can minimize blood transfusions.

• PRE-HOSPITALIZATION

During the visit the patient’s current health state will be thoroughly investigated. For this reason, it is necessary to bring all relevant health information concerning the current or previous pathologies and/or any previous surgical interventions. 
It is essential to declare all current pharmacological therapies, potential allergies and previous complications with anaesthesia.The most common anaesthetic practices as well as the provided measures to reduce pain, will also be explained. 
 

Patients will be given by the staff proper information about the records to be shown in order to formalize the hospitalization (for example the general practitioner’s proposal for it,  the patient’s medical record, the fiscal code, and so on) as well as other instructions for patients’ preparation: the diet to be followed in the days preceding the shelter, the appropriate physical activities to be done, relevant forbidden habits (such as smoking and drinking alcohol) and suggestions about the articles to buy, such as elasticated antithrombotic stockings or axillary crutches. The day of hospitalization is planned the afternoon preceding the operation.

• ADMISSION TO HOSPITAL

Ward guests are greeted by the healthcare staff members who will sum up all the Fast-track steps and answer to each and every question, setting patients’ mind at ease.

• THE OPERATION

The day of surgery

Early in the morning, the patient is lead to the operating room and welcomed by the anaesthesiological team, consisting of the anaesthesiologist and a nurse responsible for general care. Anaesthesia is administered according to the procedure to which the patient has consented to during the pre-hospitalization (mostly spinal anesthesia and/or epidural one and a sedation if necessary). After leaving the operating room, the patient is expected to stay in the recovery room for cardiorespiratory parameters monitoring and postoperative radiographic evaluation.

Transfer to the general ward

Patients are transferred to the general ward and welcomed by the nursing and medical staff, who evaluate any critical aspects and the sensory and motory functions of lower extremities. In the afternoon, physiotherapists perform joint mobility excercises and patients may deambulate using an antebrachial support. In the following days (postoperative day one and next) the impact of increased duration of exercise therapy on functional recovery should led to patients’ autonomy in stair ascending and descending using axillary crutches, and they should perform a simulation of vehicle ingress and egress as well.

• DISCHARGE

Usually patients are discharged on the 4th postoperative day (by previous agreement) or, alternatively, transferred to a medical rehabilitation ward. At the moment of discharge, further radiological tests and orthopaedic examinations are planned.
 
 

EARLY INTERVENTION SERVICE

International guidelines show how behind an increased risk of patient’s mortality and disability there are longer waits of time for orthopaedic prosthetic surgery emergencies. As a rule, in Fondazione Poliambulanza patients undergo the operation they need within 48 hours from the admission to the hospital.

According to Agena’s data (an important public authority dealing with the evaluation of national and regional health services), Fondazione Poliambulanza’s Orthopaedic and Traumatology Department is ranked among the top ten Italian wards for treating femoral neck fractures in elderly people. Actually, the entire traumatology emergencies contingent upon the First Aid are managed within 24/36 hours with technical solutions and cutting edge materials so as to ensure patients’ most rapid recovery.
 

INTERNIST /GERIATRICIAN

Department’s patients can count on internal medicine’s geriatricians qualified to meet their health care needs together with physiotherapists who set a rehabilitation programme suited for every patients in the early post-operative.