Published on 21. February 2019

Get up faster, recover better

With the "Fast Recovery" concept implemented at the Vivantes Endoprosthetics Center, patients with new hip and knee joints quickly become mobile again.

Those who decide to have a new hip or knee joint often experience pain for many years. To keep discomfort to a minimum after insertion of the prostheses and to enable good rehabilitation, bed rest is no help - on the contrary, patients should get moving again as soon as possible after the operation. "With us, they are usually already standing up again on the first day after the operation, and they are supported and guided by a physiotherapist," says Dr. Heiko Spank, head physician of the Clinic for Special Orthopedic Surgery and Trauma Surgery at the Vivantes Auguste-Viktoria Hospital, which is part of the Endoprosthetics Center. The concept he works with is called "fast recovery" - which stands for "quick recovery," and "fast" here is also synonymous with "better." "The sooner you're back on your feet after an operation like this, the better your body can recover," explains the head physician.

Not an emergency - but an elective procedure

According to Dr. Heiko Spank, when patients who have undergone surgery are in bed for several days, it puts a strain on their circulation and weakens their muscles. But the psyche also plays a role: "Many people associate a stay in a clinic with being sick, and they feel that way." They think that what they need most of all is rest and relaxation. But short-term mobilization offers the chance to return to everyday life more quickly and with more power.

A change in thinking is needed here. Patients with severe wear and tear on their hip or knee joints suffer much: "But surgery is not an emergency, it is an elective procedure. They make a conscious decision to have a joint artificially replaced because their quality of life is limited," emphasizes Dr. Heiko Spank. He adds that his patients are usually physically healthy. "I make that very clear in the preliminary discussions so that they understand that they can and should be mobile again immediately after the operation."

Gentle anesthesia - gentle surgery

Before the operation, there are several appointments in which the head physician and his team prepare the patients for the time afterwards. "This includes preoperative physical therapy, where they already try out supports - so they know how it feels to use them and walk with them." Anesthesia is another very important factor in ensuring the quickest possible recovery: "We work with the gentlest and most well-tolerated means possible, preferring, for example, anesthesia via the spinal cord to general anesthesia." At the same time, he says, good pain medication is essential: patients should feel no pain at all.

It is also possible to wear video goggles during surgery - they provide distraction and relaxation. "The overall atmosphere should be one in which the patient feels comfortable," reports Dr. Heiko Spank. "Because that can have a far-reaching effect on recovery time." All these preparatory measures are followed by surgery that is as gentle as possible: "We work in a „low-blood“ way that is gentle on the tissue to create the best conditions for rapid mobilization." Minimally invasive methods are used for this purpose and drugs are used to stop bleeding. "The successes are measurable: the transfusion rates in the approximately 700 patients we provide endoprosthetic care to per year are now only about 2 percent. In the past, it was still around 40 percent," says the physician. "We also work without drains as far as possible, because they not only increase the risk of infection, but would also give the operated patients on a stronger feeling that they were ill."

Good planning and aftercare

When those who have undergone surgery leave the clinic, they are able to walk safely on one level as well as on stairs. This is followed by rehabilitation of about four to five weeks, which can be seamlessly followed by good planning: "We inform social services a few weeks before surgery, which can secure a treatment place." After rehab, those undergoing treatment can then usually manage their daily routine well again. One should plan on about three months until complete recovery. Technically, the inserted prostheses are immediately fully load-bearing. "The tissue is of course affected by the operation, it has to heal. But load-bearing can still take place, and it makes a lot of sense." "Fast Recovery" also means strengthening the patients' personal responsibility - of course, basically under medical supervision. "Our goal is not for them to free up a bed as soon as possible, but it's about a good healing process, which can be greatly supported by short-term mobilization. There are, after all, risks associated with lying in bed, such as the risk of thrombosis." Almost all patients who have undergone surgery get back on their feet quickly: "Only a very few may have circulatory problems and therefore need a little longer," sums up Dr. Heiko Spank. "But as a rule, the concept works very well."

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