Joints play an important role in daily physical activity. However, joints will gradually wear down with age, which leading to degeneration of cartilage, bone, and surrounding tissues, cause in osteoarthritis eventually. Symptoms often include persistent pain, stiffness, muscle weakness, and a sensation of joint locking or reduced flexibility. Many people mistakenly attribute these issues to normal aging, causing them to be overlooked. If left unaddressed, these conditions can worsen and result in damage or tears to ligaments or cartilage, as well as joint deformities.
Commonly affected areas include the knee and hip joints, particularly during weight-bearing activities such as lifting heavy objects or climbing stairs. Pain may worsen after prolonged standing or walking but can improve with rest. Additionally, conditions such as congenital joint dysplasia, avascular necrosis, rheumatoid arthritis, and gout can also contribute to joint wear and damage.
In orthopedic therapies, total joint replacement surgery combined with postoperative rehabilitation exercise were commonly conducted for patients’ daily lives significantly impacted by severe joint damage. This approach aims to increase joint range of motion, weight-bearing capacity, and walking distance, ultimately improving quality of life. However, the surgery comes with various inconveniences, including prolonged fasting and fluid restrictions prior to the operation, leading to discomfort from hunger and thirst. Patients may suffer from pain, limbs swelling, and wound bleeding after surgery. Additionally, lower limb surgery can result in mobility challenges and increased fall risk, further affecting daily living.
To address these challenges, the orthopedic department of our hospital has implemented the “Enhanced Recovery After Surgery (ERAS) care model” for holistic postoperative care of total joint replacement patients. International studies revealed that this care model can reduce hospital length of stays by 30% and decrease surgical complications by 50%, facilitating faster recovery after surgery.
In our hospital, the ERAS team consists of orthopedic surgeons, nurses from the orthopedic wards W11 and W12, as well as anesthesiologists, nutritionists, pharmacists, and physiotherapist. The ERAS team provide continuous and comprehensive care collaboratively for patients undergoing joint replacement surgery, could organized into three phases:
1.Preoperative Phase: The orthopedic surgeon and anesthesiologist coordinate comprehensive blood tests, X-rays, cardiac assessments, and anesthesia evaluations. Nurses provide preoperative care and patient educations on important information and considerations of surgery. Nutritionists conduct nutritional assessments and offer counseling, arranging for "ERAS-specific meals" that consist of high-sugar powder which can solute to clear liquids. After fasting from solid foods since midnight before surgery, patients would be allowed to drink ERAS meals until 6 AM on the operation day, which may alleviate the discomfort of prolonged hunger and thirst. Additionally, pharmacists assess medications for diabetes and anticoagulants to maintain appropriate blood sugar levels and reduce bleeding risks, while also providing customized pain management dosage recommendations. Before surgery, physiotherapists teach muscle strength and endurance training exercises in advance to ensure a smooth transition to early rehabilitation after surgery.
2.The Day of Surgery and Intraoperative Phase: Nurses administer prophylactic antibiotics to reduce the risk of infection. During the surgery, the anesthesiologist adjusts the dosages of analgesics and anesthetics precisely, and prevent patient from hypothermia under close monitoring. Meanwhile, the orthopedic surgeon collaborate with the anesthesiologist to adjust anticoagulants in order to minimize bleeding during the procedure.
3.Postoperative Phase: Nurses closely assess the surgical site, providing wound care and patient education. They also assess pain scale closely and provide active pain management, collaborating with pharmacists and physicians to adjust dosages based on patient needs. Nutritionists evaluate the caloric requirements for recovery and ensure a balanced diet. Orthopedic surgeons conduct daily assessments for any postoperative complications and aim to remove drainage tubes as soon as appropriate. Physiotherapist provide daily bedside guidance on quadriceps exercises, ankle pumps, heel slides, and other muscle strength and endurance training activities, as well as techniques for turning and getting out of bed, promoting early mobilization to enhance recovery.
The ERAS team provide three-phase holistic care to accelerates postoperative recovery, continuously guarding patient health. Aiming to support patients to regain daily life activity with strong legs and flexible joints as soon as possible after surgery, which may lead to a comfortable, joyful, and vibrant life.