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Changing the philosophy of recovery from Hip and Knee replacements; Musgrove Park Hospital Experience from the launch of Day Case and Ambulatory Arthroplasty

Ben Bolland

Ben Bolland, Joseph Tyrell, Deborah Vile
Musgrove Park Hospital, Taunton, Somerset, United Kingdom



2021 Post pandemic resulted in long surgical and operation waiting list times.


To tackle this problem a new ambulatory arthroplasty pathway (AAP) was established with a focus on patient education and consistent messaging. An initial day case pilot was performed (Sept 22 – Feb 23) of 12 THR patients followed by the launch of the full AAP in May 2023.d.


11/12 patients went home the same day. Average time from leaving theatre to first standing was 2hrs 4mins. Average length of stay from beginning of operation to discharge was 7hrs 54mins. Patient satisfaction scores were good / excellent in 100%. The average LOS for all arthroplasty patients dropped from 3.3 to 2.1 days with a 150% increase in patients going home same day or day 1, and 47% increase in the proportion of patients sent home Day 1.
Having established patient safety, improved satisfaction, the AAP was launched. Since its launch until the end of 2023, 349 patients underwent a THR / TKR. Over 80% were eligible for the AAP. 64% of patients went home Day 0,1. The average LOS for AAP patients fell to 1.37, and 2.06 for all patients.


We have demonstrated that with no extra resource but a change in philosophy through patient education and consistent messaging the default LOS for patients undergoing THR / TKR can be 0 or 1. Although Day Case arthroplasty is an integral part of the pathway the most profound effects are seen in the number of patients going home on Day 1.