UCLH doubles its hip and knee operations following move to new building

The orthopaedics team has doubled the number of hip and knee operations carried out this year despite pandemic pressures, as the new Grafton Way Building (GWB) and a new model of care have significantly helped reduce patient waiting times. 

In the 12-month period since the move to GWB in April 2021, the team has carried out 1442 hip and knee procedures compared to 748 in 2019/2020. 

The team has also reduced the average length of time that patients stay in hospital from four days to two and a half for total hip replacements and from five days to three for total knee replacements. 

Several factors have contributed to the increased number of operations and reduced length of stay. 

The new building has a dedicated unit with ring-fenced beds and theatres for elective surgery, so theatres and beds are not appropriated for emergency care, as can happen at University College Hospital.  

A dedicated ward and theatres mean less delays and cancellations. Transit delays are avoided because patients are admitted to a ward located right next to theatres. The number of elective surgery beds has increased from 16 to 22 with the capacity to increase to 32 if needed. 

Two dedicated clinical nurse specialists meticulously plan for each patient to ensure there are no delays in admitting them and that they are prepared for what to expect before, during and after their operation. Alongside them are the expert physio and occupational therapists who quickly get patients up and confident walking so that they can be discharged home as soon as it is safe to do so. 

Surgeons use three Mako robots, funded by UCLH Charity, for 90 per cent of hip and knee operations. Robotic surgery means increased accuracy and less damage to surrounding tissue means patients experience less pain, and recover more quickly. 

UCLH works jointly with the Whittington Health NHS Trust to deliver orthopaedic services, with two joint consultant surgeon, three Whittington surgeons operating in the GWB theatres and one UCLH surgeon operating at the Whittington. Several anaesthetists and trainee surgeons also take part in operating lists at GWB. Day case orthopaedic surgery is carried out at the Whittington.

Consultant surgeon Mr Sam Oussedik, UCLH clinical director of trauma and orthopaedics said: “Doubling the number of hip and knee operations we carry out in a year has been an incredible team effort, combined with the excellent facilities that the University College Hospital Grafton Way Building provides. Orthopaedic surgery would often be cancelled if there were issues with a lack of beds in our hospitals. With our ring-fenced ward and theatres, we now avoid delays and cancellations.  

“Our dedicated clinical nurse specialists, physios and occupational therapists put a huge amount of work into preparing our patients for surgery and rehabilitating them afterwards and getting them back home quickly and safely. The reduced average length of stay allows the surgical teams to carry out more operations.” 

Anna Bruce, matron for surgical specialties, said: “The preparation prior to our patients coming in for their surgery is vital. This includes a detailed pre-assessment session with a nurse and an anaesthetist, attending ‘joint school’ which is now virtual since the start of the pandemic, and a telephone conversation with the therapy and nursing team. During the latter we will clearly set out expectations for patients that our plan will be to get them up and home as quickly as possible after their operation. We also make sure that they have all the right support at home and any issues are picked up before we admit them.” 

Geoff Bellingan, UCLH medical director, surgery and cancer board, said: “Congratulations to the whole of the elective orthopaedic team for this impressive and significant achievement, with everyone, including the admin staff, working together to make it happen. It is often hard to see the amount of effort that is put in because they make it look seamless. 

“It’s worth noting the high complexity of cases being treated within this reduced length of stay  – these were cases on hold throughout the pandemic, who are now being treated with appropriate work up and post-op care.” 

The vision for the GWB to reduce waiting times for elective surgery pre-dates the pandemic. However, funds from the Integrated Care System (ICS) area accelerator system for elective recovery have been used to further enhance what the team are able to deliver. 

Patient case study 

Hairdresser, Mark Pittman, age 61, had a total hip replacement on 12th April. 

Mark said: “I hadn’t been in hospital since I was twelve years old so I didn’t really know what to expect and I have nothing to fault. The service was fantastic from start to finish. I was well communicated with the whole way through. I was up and walking with a crutch the afternoon of my surgery, went home the following day and started back at work two weeks later.” 

Read about this story in the Evening Standard.