Date of release: 13 May 2021
Patient Linda Tilt from Burntwood
The Royal Wolverhampton NHS Trust has started offering total shoulder replacement surgery as a day-case procedure to selected patients. Previously, patients needed to stay in hospital for two to three days following this procedure but they can now return home on the same day as their operation.
Mr Adrian Simons, Consultant Orthopaedic Surgeon and Dr Anil Singh, Consultant Anaesthetist, introduced the procedure at the Trust in January 2020, but elective surgery was paused due to the COVID-19 pandemic. The procedure returned when limited elective surgery resumed after the first lockdown.
Mr Simons said: “We carry out around 60 shoulder replacements a year, and we would hope between 10 and 20 per cent might be suitable as day cases. However, as our experience grows, that proportion will increase, therefore we can save between 12 and 20 bed-days per year. That will allow my colleagues who perform surgery on lower limbs to admit other patients for hip and knee replacement operations.”
Dr Singh uses a ‘nerve block’ technique where he injects local anaesthetic around the nerves of the shoulder under ultrasound guidance, prior to surgery. This provides pain relief in the shoulder area during and after the operation, taking effect within 5-10 minutes and lasting up to 18-24 hours. Use of ultrasound makes this technique highly successful and safe.
In addition, the patient receives general anaesthesia using something called the total intravenous method that helps them to recover quickly with reduced incidence of common side effects such as nausea, vomiting and drowsiness. All patients who have had this must be accompanied when they leave hospital.
Linda Tilt underwent replacement surgery in both shoulders as day cases. The 71-year-old grandmother from Burntwood, a retired business manager of a primary school, had her right shoulder replaced in July 2020 and her left in April 2021. For her first operation, Linda was seen by a physiotherapist before she left hospital and was then treated via Zoom calls due to the restrictions of the pandemic. For the second one, she was doing light exercises within a week of surgery.
She said: “The treatment was first class I couldn’t fault it. The team was very professional and I felt very safe. Dr Singh administered the anaesthetic so I was asleep before the nerve block. For both operations I went in in the morning and was out by late afternoon.
“I came out with no pain or discomfort. I just took Co-codamol for about a week and then stopped taking painkillers. Dr Singh couldn’t have been more attentive – he rang me at home on a couple of occasions to see if I was OK.”
Linda is now looking forward to getting her independence back, such as simple things like dressing herself. “I haven’t driven a car for over 12 months, which I’m told I can do within six to eight weeks, so that will be great,” she added. “I also used to love crafting and I’ve got drawers full of buttons and bows, so I’m looking forward to doing that and playing with my grand-daughter. I hope what I have done will inspire others to do the same.”
Mr Simons added: “This is a good example of innovation, which we are all looking for to help overcome waiting lists that are unfortunately an inevitable effect of the pandemic. We hope eventually our example will encourage colleagues to look at day-case treatment for other joint replacements, although it should be kept in mind joint replacement surgery is generally required in elderly patients, not all of whom will be medically fit to be considered as day cases.”
Notes to Editor
- For further information, please call Tim Nash on 01902 447297 or email firstname.lastname@example.org
- Day-case shoulder replacement is more common in the United States than here. Some papers suggest there is a lower risk of complications in patients treated as a day case compared to staying overnight. There are limited examples in the UK and US of patients undergoing total knee and hip replacements as day cases.