Victoria hospital offers innovative same-day hip and knee replacement surgery

Seventy-one-year-old Dan Kelly says he was in disbelief when he left the Royal Jubilee Hospitalin Victoriathree hours after a total hip replacement.

"I did a little jig right after I got off the bed," he recounted. "I walked about 30 feet to the bathroom. That was just an hour after my surgery. It was unbelievable."

By noon he felt good enough to go home.

Kelly is one of eight trial patients who've had hip or knee replacement surgery under Island Health's new Victoria Enhanced Recovery Arthroplasty (VERA) program, over the past year.

Lead orthopedic surgeon Dr. Duncan Jacks says hip and knee replacements are in high demand, and the program involves a new way of controlling pain and anesthesia before, duringand after surgery, to drastically improve patient recovery.

Under the new protocols, patients who are "reasonably healthy" are given a number of medications before their operation "to target all the different pain pathways ... before the pain sets in,"said Jacks.

Patients are also injected with anesthetic into the epidural space outside the spinal fluid, rather than into the fluid directly, "allowing the patient's motor-function to recover almost immediately."

Jacks said his team is also trying to minimize soft tissue damage through different cutting techniques, and is using specialized sutures and dressing materials to minimize drainage from surgical wounds.

Together, these procedural changes have produced amazing outcomes for patients, Jacks said, adding that they'd traditionally feel nauseous, groggy and dizzy, and would have to stay in the hospital for up to a few days post-operation.

Kelly, who had his first hip replacement using the old method, said his first surgery was painful, he was kept in the hospital overnight, and he wasn't able to move his leg properly for a couple of weeks. Under the new program, Kelly was told to treat his leg "as normal."

"That night, I slept on the side of the hip they operated on. In the morning, I walked out onto my deck, had a coffee, and didn't even feel like I had an operation," he said.

Surgical methods from Montreal

Jacks said he's adapted his methods from Quebec surgeon and clinical researcher Pascal-AndrVendittoli, after learning about them during an orthopedic conference a couple of years ago. Jacks then arranged for his team to meet Vendittoli in an operating room in Montreal, in December 2018, to observe a procedure.

"I was blown away by how fast these patients were mobilizing," he said. "One of the most frustrating things as a surgeon is to see your patients struggling after a big operation ... but it doesn't have to be that way."

Vendittoli, who works at the Maisonneuve-Rosemont Hospitalin Montreal, said he developed his surgical method based off of Enhanced Recovery After Surgery (ERAS) principles, which originated in Denmark, and have been used in various hospitals across Canada for the past five years.

Vendittoli said his hospital was the "first to do [same-day] joint replacement surgery with ERAS principles" in 2016. Since then, his team has trained 18 other Canadian medical teams, including in surgical units in Kelowna, B.C., Alberta, Ontario, New Brunswick and Quebec.

Jacks to expand program to other surgeries

In Victoria, Jacks said the new protocols will meet the increasing demand for joint replacements, and will cut costs for the hospital and patients, due to less time spent in recovery.

Jacks says he hopes to expand his program to other types of surgery, and has formed a committee of nurses, pharmacists, physiotherapists and other health professionals, to develop a "fully-fledged, standardized protocol" for Island Health.

He said he's already performed operations on two more patients this summer, and all 10 patients have left the hospital on the same day as their surgeries,without complications.