Skip to content

Recent articles from the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement in Denmark

2012 May 8
Comments Off on Recent articles from the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement in Denmark
by webmaster

During our recent lecture tour of Australia we were fortunate to meet lots of people doing some great work in orthopaedics. One person who really impressed us was Joanne Kenny from Austin Health in Melbourne. During the course of our conversations I spoke to her about the current evidence-base in orthopaedic enhanced recovery and I mentioned the impressive research work being completed in Denmark at the Lundbeck Centre. I recently shared a list of useful references with Joanne from the centre which I have detailed below. It’s a great reading list for anyone involved in orthopaedic enhanced reocvery.


1. Husted H, Andersen KV, Soballe K. Convalescence and sick leave following total knee and hip arthroplasty. Ugeskr Laeger 2009; 171:2892-2896.

2. Holm B, Kristensen MT, Myhrmann L, Husted H, Andersen LO, Kristensen B, Kehlet H.The role of pain for early rehabilitation in fast track total knee arthroplasty. Disabil Rehabil 2010; 32:300-306.

3. Andersen LO, Husted H, Kristensen BB, Otte KS, Gaarn-Larsen L, Kehlet H. Analgesic efficacy of subcutaneous local anesthetic wound infiltration in bilateral knee arthroplasty: a randomized, placebo-controlled, double-blind trial. Acta Anaesthesiol Scand 2010; 54:543- 548.

4. Andersen LO, Kristensen BB, Madsen J.L, Otte KS, Husted H, Kehlet H. Wound spread of radio labeled saline with multi- versus few-hole catheters. Reg Anesth Pain Med 2010; 35:200-202.

5. Kehlet H, Soballe K. Fast track hip and knee replacement – where are the issues? Acta Or- thopaedica 2010; 81:271-272.

6. Husted H, Otte KS, Kristensen BB, Ørsnes T, Wong C, Kehlet H. Low risk of thromboembolic complications in a fast track set up with hip and knee arthroplasty. Acta Orthopedica 2010; 81:599-605.

7. Husted H, Solgaard S, Hansen TB, Søballe K, Kehlet H. Care principles of four fast track arthroplasty departments in Denmark. Dan Med Bull 2010;57:A4166 1

8. Andersen LO, Husted H, Kristensen BB, Otte KS, Gaarn-Larsen L, Kehlet, H. Analgesic efficacy of local anaesthetic wound administration in knee arthroplasty. Volume vs. concentration. Anaesthesia 2010; 65:984-990.

9. Andersen LO. Husted H, Kristensen BB, Otte KS, Gaarn-Larsen, Kehlet H. Analgesic efficacy of intracapsular vs. intraarticular local anaesthetics after knee arthroplasty. Anaesthesia 2010;64:904-912

10. Andersen KV, Bak M, Christensen BV, Harazuk, Pedersen NA, Søballe K. A randomized controlled trial of local infiltration analgesia vs. epidural infusion for total knee arthroplasty. Acta Orthopedica 2010; 81:606-610.

11. Husted H Otte KS, Kristensen BB, Ørsnes T, Kehlet H. Readmissions after fast track hip and knee arthroplasty. Arch Orthop Trauma Surg 2010;130:1185-1191

12. Holm B, Kristensen MT, Bencke J, Husted H, Kehlet H, Bandholm T. Loss of knee-extension strength is related to knee swelling after total knee arthroplasty. Arch Phys Med Rehabil 2010; 91:1770-1776.

13. Krenk L, Rasmussen LS, Kehlet H. New insights into the pathophysiology of postoperative cognitive dysfunction. Acta Anaesthesiol Scand 2010;54:951-956

14. Larsen K, Hansen TB, Søballe K, Kehlet H. Patient reported outcome after fast-track hip arthroplasty and the need for additional rehabilitation. Health Quality Life Outcomes 2010; 8:144-154.

15. Jans Ø, Kehlet H, Hussain Z, Johansson P. Transfusion practice in hip arthroplasty – a nationwide study. Vox Sanguinis 2011: 100: 374-380

16. Lunn TH, Kristensen BB, Andersen LØ, Husted H, Otte KS, Gaarn-Larsen L, Kehlet H. Effect of high-dose preoperative methylpredisolone on pain and recovery after total knee arthroplasty: a randomised, placebo-controlled trial. Br J Anaesth 2011; 106:230-8. 2

17. Husted H, Troelsen A, Otte KS, Kristensen BB, Holm G, Kehlet H. Fast-track surgery for bilateral total knee replacement. J Bone Joint Surg 2011; 93-B: 351-6.

18. Holm B, Kristensen MT, Husted H, Kehlet H, Bandholm T. Thigh and knee circumference, knee extension strength, and functional performance after fast-track total hip arthroplasty. Phys Med & Rehabil 2011; 3: 117-24.

19. Jans Ø, Johansson P, Kehlet H. Blood transfusion in major orthopaedic surgery? Ugeskr Laeger 2011; 173: 815-817.

20. Krenk L, Rasmussen L.S. Postoperative delirium and Postoperative cognitive dysfunction in the elderly – what are the differences? Minerva Anestesiologica 2011;7:742-49

21. Lunn TH, Husted H, Solgaard S, Kristensen BB, Otte KS, Kjærsgaard AG, Gaarn-Larsen L, Kehlet H. Intraoperative local infiltration analgesia for Early Analgesia after total hip arthroplasty: A randomized double-blind placebo controlled trial. Reg Anesth Pain Med 2011; 5:424-29.

22. Otte K, Husted H, Ørsnes T, Kehlet H. Bilateral simultaneous total hip arthroplasty in a fasttrack setting. Hip International 2011; 3:336-339.

23. Andersen L, Otte KS, Husted H, Gaarn-Larsen L, Kristensen B, Kehlet H. High volume infiltration analgesia in total hip arthroplasty. A randomized, double blind placebo controlled trial. Acta Orthopedica 2011;82: 23-426

24. Kehlet H, Andersen LØ. Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice. Acta Anaesthesiol Scand 2011; 7:778-784.

25. Husted H, Troelsen A, Kehlet H. Undocumented regimes in hip and knee replacement surgery may impair treatment outcome. Ugeskr Laeger 2011;25:1802-1805.

26. Husted H, Otte KS, Kristensen BB, Kehlet H. Fast-track revision knee arthroplasty – a feasibility study. Acta Orthopedica 2011;82 :438-40.

27. Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why in hospital after fast-track hip and knee arthroplasty? Acta Orthopedica 2011; 82:679-684. 3

28. Husted H, Munk Jensen C, Solgaard S, Kehlet H. Reduced length of stay following hip and knee arthroplasty in Denmark 2000-2009. Acta Ortop Trauma Surg 2012; 132:101-104.

29. Munk S, Dalgaard J, Bjerggaard K, Andersen I, Hansen T. B, Kehlet H. Early recovery after fast-track Oxford unicompartmental knee arthroplasty, Acta Orthopedica 2012; 83:41-45.

30. Jakobsen TL, Husted H, Kehlet H, Bandholm T. Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: Is it feasible? Disability Rehabil 2011; (e-pub)

31. Jans O, Bundgaard-Nielsen M, Solgaard S, Johansson PI, Kehlet H Orthostatic intolerance during early mobilization after fast-track total hip arthroplasty. Br J Anaesth 2012;108:436- 43

32. Holm B, Husted H, Kehlet H, Bandholm T. (2011) Effect of knee joint icing on knee- extension strength and knee pain elderly after total knee arthroplasty: A randomized cross- over study. Clinical Rehabilitation (e-pub)

33. Krenk L, Rasmussen LS, Bæk-Hansen T, Bogø S, Søballe K, Kehlet H. Delirium after fast- track hip and knee arthroplasty. Br J Anaesth 2012; 108:607-11.

34. Kjærsgaard-Andersen P, Kehlet H. Deep venous thrombosis prophylaxis in fast-track hip and knee replacement? Acta Orthop. 2012 (e-pub)

35. Lange J, Troelsen A, Thomsen RW, Søballe K. Chronic infections in hip arthroplasties: The risk of infection in one-stage and two-stage revisions – systematic review and meta- analysis. Clin Epidemiol 2012:57-73

36. Larsen K, Hansen TB, Søballe K, Kehlet H. Patient-reported outcome after fast-track knee arthroplasty. Knee Surg Sports Traum Arthrosc 2012 (e-pub)

37. Bandholm T, Kehlet H. Physiotherapy exercises after fast-track total hip and knee arthroplasty – time for reconsideration? Arch Phys Med Rehabil (e-pub) 4

38. Lunn T, Kristensen B, Gaarn-Larsen L, Husted H, Kehlet H. Post Anaesthesia Care Unit stay after total hip and knee arthroplasty under spinal anaesthesia – a prospective, observational study. Acta Anaesthesiol Scand 2012 (in press)

39. Munk S, Jensen NJF. Andersen I, Kehlet, H, Hansen TB. Effect of compression therapy on knee swelling and pain after total knee arthroplast. Knee Surg Sports Traum Arthroscopy 2012 (in press)

40. Jans Ø, Johansson P, Kehlet H. Mortality after primary total hip arthroplasty and possible relations to transfusion. Vox Sanguinis 2012 (in press)


Enhanced Recovery at the International Forum for Quality and Safety in Healthcare

2012 April 20
Comments Off on Enhanced Recovery at the International Forum for Quality and Safety in Healthcare
by webmaster

Here are the slides from today’s workshop. Please get in touch via the contact form with any questions or queries.

If you have a good example of enhanced recovery that you would like to share please also get in touch.

The aim is to help the spread of good ideas on enhanced recovery after surgery.


Orthopaedic Enhanced Recovery Masterclass

2012 March 12
by webmaster

Here are the slides from our recent workshops in Australia and New Zealand. A full reference list will follow in the next couple of days.

Please get in touch with any questions.








Enhanced Recovery Video Podcasts on the Wessex HIEC Website

2012 February 26
by webmaster

Follow the link below to view Enhanced Recovery video podcasts on the Wessex Health Innovation and Education Cluster (HIEC) Partnership website. The website is called PIPER and it’s purpose is to identifies and accelerate the spread of good ideas in health and care services that improve outcomes for patients  and that make the best use of health and care service resources. The aim is to make the transfer of good ideas simple, immediate, and accessible.

Click here to view the video podcasts.


NHS Improvement Enhanced Recovery Summit

2012 February 26
by webmaster

Are you going to the NHS Improvement Enhanced Recovery Summit on the 30th April 2012 at the Lancaster London Hotel?

The summit is free for NHS clinicians and managers from primary and secondary care, commissioners, social care, patients, carers and charitable organisations from across the health and social care community.

The day will draw on a wide range of local, national and international expertise, covering policy, managerial, clinical and commissioning knowledge. The summit aims to support the adoption of Enhanced Recovery principles and practices’ in elective and emergency pathways (surgical and medical) across England: with key note speakers, debates, Q&A, and show and tell sessions.


Click here for more information and to register

Click here to submit an abstract



Enhanced Recovery – Australian hospitals can learn from the UK experience

2011 December 16
Comments Off on Enhanced Recovery – Australian hospitals can learn from the UK experience
by webmaster

Earlier this year Bernarda Cavka visited the UK to attend the 1st National Enhanced Recovery Conference in Bath. During her stay she also visited some hospitals utilising enhanced recovery pathways, seeking to learn from the sites in order to help inform her own hospital’s implementation of enhanced recovery.

Bernarda works as a Physiotherapy Team Leader at he Royal Melbourne Hospital, Australia and after her visit she sent us the following guest blog with her reflections of her visit to Bournemouth.

Enter Bernarda…

In August this year I had the opportunity to visit the Royal Bournemouth Hospital (RBH) to observe the multidisciplinary team management of their elective hip and knee arthroplasty patients and gain a further understanding of how the team have achieved such great results with patient satisfaction, clinical outcomes, and length of stay. I was particularly interested to hear about RBH’s experiences with the implementation of the principles of enhanced recovery which is a relatively new concept in public health in Australia.

From the outset it was evident that a cohesive, innovative and highly structured team is the key ingredient to drive any change and achieve success with short term and long term goals. The team had the same vision and objectives regarding patient care which were consistently communicated to the patients and family members at varied stages of the pathway. In particular, the preoperative MDT education sessions provided patients with a clear understanding of what to expect from the time they were admitted onto the unit until discharge home including the importance of effective pain management, day of surgery mobilisation and the promotion of independence with self care.

Discussions with Tom Wainwright reinforced the importance of data collection to monitor processes and clinical outcomes along the patient journey, in engaging staff and as a mechanism of feedback to the MDT and executive management regarding the performance of the unit. Their use of SPC charts provides live information regarding LOS which facilitates more timely detection of variance in clinical practice which may be adversely affecting the patient experience and outcomes.

Overall, visiting the RBH was a fantastic experience which demonstrated how the patient experience and clinical outcomes can be improved through the implementation of an enhanced recovery pathway which is aligned with best practice guidelines. Thanks to Tom and Rob for their hard work in developing and sustaining the Enhanced Recovery Blog. The site has been a valuable tool for us in Melbourne as we move forward in reviewing our own hip and knee arthroplasty pathway.

Bernarda Cavka, Physiotherapy Team Leader, Acute Orthopaedics, The Royal Melbourne Hospital, Australia (Bernarda’s trip to the UK was funded by a grant from the Felice Rosemary Lloyd Trust which is managed by ANZ Trustees).


If you are based in Australia or New Zealand and would like to learn more about how to design, implement, and manage a high performing enhanced recovery pathway in orthopaedics, follow the link below to get details of upcoming masterclasses near you.

Orthopaedic Enhanced Recovery Master Classes with Change Champions 





Patient experience and enhanced recovery

2011 December 8
by webmaster

Much of the focus when introducing enhanced recovery pathways is about reducing length of stay. However, we must never forget that the primary focus of the approach is to improve patient care. In this blog post I link to an article recently published in the journal BMJ Quality and Safety and written by a noted French ethnographer.

In the article he describes his care in a French private hospital for a hip replacement. He recounts a number of events that are probably typical of many patients’ hospital experiences, and are essential for all of us to always keep in mind. The observations are probably similar to those patients might make after exposure to any modern healthcare system, except that they offer a level of detail few would provide. The account focuses on the contradiction between excellent technical operations and the absence of compassionate patient care, basic civility and the needs of patient safety.

Here is the link to the article

For want of a four-cent pull chain

If you are unable to access, get in touch via the contact form and we will email you a copy.

Orthopaedic Rapid Recovery in the Dr Foster Hospital Guide

2011 December 8
by webmaster


In the  2011 Dr Foster Good Hospital Guide Questionnaire every english hospital was asked questions about their joint replacement pathway.

The questions asked about compliance to widely agreed and understood elements of an enhanced recovery (rapid recovery) pathway and were then analysed against length of hospital stay. To see the full report go to  page 34 of the guide by clicking on this link  2011 Dr Foster Guide

Enhanced recovery after total knee athroplasty

2011 September 5
by webmaster

Click here to see the recently published article by David McDonald and colleagues.

David and his colleague Dr Scott will both be at the National conference later this week sharing their experiences and expertise.

Department of Health’s two-year evaluation on the effects of implementing enhanced recovery

2011 September 2
by webmaster


Next week Dr Ann Driver (NHS Improvement Director) will be presenting at the UK Conference on Enhanced Recovery. Ahead of her presentation, Emma Dashfield (Communication Manager at NHS Improvement) provides us with an update on her recent work, and some valuable links to enhanced recovery resources.

Enter Emma…….

Anne Driver and Dr Alan Nye (Clinical Advisor for Elective Care at the Department of Health) recently spoke to GP Magazine in respect to the Department of Health’s (DH) two year evaluation on the effects of implementing enhanced recovery and its principles. The article explains how length of stay for the patient in hospital has reduced by 25% over the course of the 2 year DH project.

Click here to access the GP Magazine article which further explains the effects to GPs and the benefits to patients by implementing enhanced recovery techniques.

To further raise the raise the profile and build the clinical evidence of ensuring patients are fit for surgery, given best surgical care and receive best post-operative rehabilitation Dr Ann Driver also recently spoke to the HSJ (August 2011) on  ‘How enhanced recovery is transforming surgical care pathways’.  Click here to see this article (subscription may be required).

Further information on the work behind the enhanced recovery programme which also contains a whole range of case studies successfully implementing the enhanced recovery methodology and principles to surgical pathways and to access the enhanced recovery toolkit can be found on the NHS Improvement website.

Recent reported success stories across England have been on the positive effects to the patients length of stay and experience in implementing the enhanced recovery principles along the breast surgical pathway in the delivery of major breast surgery (excluding reconstruction). NHS Improvement working in partnership with clinical teams in 72 NHS Acute sites across England (within 13 clinical spread networks) and supported by  the British Association of Day Surgery and Breakthrough Breast Cancer; tested the hypothesis that the streamlining of the breast surgical pathway could reduce unnecessary lengths of stay by 50%, by managing the patients expectations, changing clinical practice and ensuring that the pathway is efficient, without the loss to quality, safety and patient outcomes.

To access the case studies please click on the following link: Delivering major breast surgery as a day case or a one night stay (excluding reconstruction) case studies

Also soon to be available on the NHS Improvement website is a range of seven day working principle case studies across different patient’s pathways in order to improve quality, outcomes and contribute to reduced length of stay in hospital. For further information go to