Prosthetic surgery of the large joints has seen major improvements in instrumentation and prosthetic design in recent years. Prof. Simone Cerciello, expert in Orthopaedics and Traumatology in Rome, explains.
What are the results obtained today in prosthetic surgery?
Patients have benefited in terms of reduced hospitalisation and accelerated functional recovery, with a very rapid return to a normal life. However, in the past the pathology was often placed at the centre of the therapeutic project. This is a reductive approach and in recent years the aim has been to overcome this view, bringing the patient back to the centre of treatment. This is only possible thanks to the interaction of different professional figures.
What does the multidisciplinary approach consist of?
Patient management therefore involves close collaboration between orthopaedic surgeon, internist, anaesthesiologist, nurse and physiotherapist. Communication and close collaboration between these professionals is at the origin of the "fast-track" concept. Full 360° patient care has been shown to bring numerous advantages both to the patient and to the healthcare system. This approach starts at the pre-admission stage with full patient information. This is a crucial point, because greater awareness and knowledge of the various phases of hospitalisation helps and empowers the patient. General health status is investigated at this stage: preventive resolution or stabilisation of any pre-existing internal conditions is fundamental to reduce risks and complications of the operation. Never as in this new approach does the saying apply: "prevention is better than cure".
What are the benefits for patients?
Surgery is obviously the heart of this approach. Anaesthesia must be "heavy" enough to guarantee patient comfort but "light" enough to allow rehabilitation on the same afternoon without a urinary catheter. Hence the use of peripheral spinal and/or epidural anaesthesia with possible sedation in about 90% of cases. During surgery great attention is paid to tissue preservation to avoid unnecessary trauma and reduce bleeding. Surgical haemostasis must be accurate in order to minimise blood loss and therefore the need for drains (which would reduce patient autonomy) and for transfusions with their associated risks. Reduction of bleeding and careful post-operative pain management are essential for the next stage: rehabilitation. From the afternoon of the operation and then at least twice a day the physiotherapist mobilises the patient and encourages walking. This multi-disciplinary approach, achieved also with innovative methods, allows early patient mobilisation, avoiding potential cardiovascular and skin complications associated with prolonged bed rest and drastically reducing the length of hospitalisation.