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Mr. Ganapathi has been instrumental in introducing day surgery hip and knee replacements at Ysbyty Gwynedd. Hip and knee replacements are usually done as inpatient procedures and patients stay in the hospital for 2-3 days. With day surgery hip and knee replacements, the patients go home within few hours after surgery. It requires a number of factors including careful selection of patients, co-ordinated multi-disciplinary team effort, minimally invasive surgery, multi-modal pain management, pre-operative education as well as buy-in by the patients and their carers in the concept. While it can reduce the cost for the hospital, early discharge has also been shown to improve patient outcome. Mr. Ganapathi has been doing day surgery hip and knee replacements since February 2020 in carefully selected patients.

Mr. Ganapathi giving an overview of Day surgery hip and knee replacements.

Day surgery hip and knee replacement program at Ysbyty Gwynedd

Interview with the first patient who had day surgery hip replacement at Ysbyty Gwynedd

Fly-on-the wall documentary of a patient who had day surgery knee replacement show casing the co-ordinated multi-disciplinary intense team effort of staff at Ysbyty Gwynedd and capturing the human emotions.

While in the videos it can be seen that some patients are able to walk unaided much earlier than usual due to minimal pain from MIS approach, Mr.Ganapathi recommends his patients to use some form of walking aid during the initial four to six weeks as a precaution.

Video of a patient one week following minimally invasive total hip replacement done as a day surgery procedure.

BBC Wales radio interview on day surgery.

Dday surgery knee replacement.

Orthop Traumatol Surg Res. 2019 Nov;105(7):1237-1243.

doi: 10.1016/j.otsr.2019.08.013. Epub 2019 Oct 3.

Enhanced recovery short-stay hip and knee joint replacement program improves patients outcomes while reducing hospital costs

Pascal-André Vendittoli 1Karina Pellei 2François Desmeules 2Vincent Massé 2Christian Loubert 3Martin Lavigne 2Josée Fafard 4Louis-Philippe Fortier 3


Introduction: An attractive option to reduce hospital length of stay (LOS) after hip or knee joint replacement (THA, TKA) is to follow the Enhanced Recovery After Surgery principles (ERAS) to improve patient experience to a level where they will feel confident to leave for home earlier. The objective of this study was to evaluate the implementation of short-stay protocol following the ERAS principles.

Hypothesis: We hypothesized that our ERAS THA and TKA short-stay protocol would result in a lower complication rate, shorter hospital LOS and reduced direct health care costs compared to our standard procedure.

Material and methods: We compared the complications rated according to Clavien-Dindo scale, hospital LOS and costs of the episode of care between a prospective cohort of 120 ERAS short-stay THA or TKA and a matched historical control group of 150 THA or TKA.

Results: Significantly lower rate of Grade 1 and 2 complications in the ERAS short-stay group compared with the standard group (mean 0.8 vs 3.0, p<0.001). No difference was found between the 2 groups for Grade 3, 4, or 5 complications. The mean hospital LOS for the ERAS short-stay group decreased by 2.8 days for the THAs (0.1 vs 2.9 days, p<0.001) and 3.9 days for the TKAs (1.0 vs 4.9 days, p<0.001). The mean estimated direct health care costs reduction with the ERAS short-stay protocol was 1489 CAD per THA and 4158 CAD per TKA.

Discussion: In many short-stay protocols, focus has shifted from ERAS goals of a reduction in complications and improved recuperation to use length of stay as the main factor of success. Implementation of an ERAS short-stay protocol for patients undergoing THA or TKA at our institution resulted not only in reduced hospital LOS, but also in improved patient care and reduced direct health care costs.