■ About the TJN
■ Implementation Strategies
■ Unilateral Knee & Hip Replacements
■ Bilateral & Revision Replacement
■ Hip Fracture Project
■ Care Maps & Tools
■ Links
■ Contact Us

Bilateral and Revision Replacements

Following the success of the implementation of care maps for Unilateral Primary hip and knee patient population the Total Joint Network worked with the partnering organizations to create care maps for bilateral hip and knee replacements as well as revision hip and knee replacements.

Literature review
On review of the literature it was identified that there was little information to guide the development of this care map. As such the original care map for primary unilateral replacements was refined based on a consensus approach.

Acute care hospitals
It was identified that there were significant differences in the presentation of these diverse patient populations however the changes that were felt to be necessary for the acute care hospitals included:

1. Weight bearing status needs to be defined by the surgeon
2. Blood transfusion may be required at Day 4 for patients who undergo bilateral surgery due to increased blood loss
3. Rehabilitation – walking and stairs may be delayed for patients who undergo bilateral surgery
4. Transfer to inpatient rehabilitation may not occur until day 4 related to potential for medical instability

Inpatient rehabilitation
Through discussion with the inpatient rehabilitation units it was identified that again there can be significant variations to the presentation of these patients with some managing extremely effectively and other having difficulties due to pain or weight bearing status. As such there was consensus that the length of stay should be 7 days in inpatient rehabilitation.

System Tracking
Monthly data is being analysed by the TJN and will be reviewed by the partnership to refine the targets and care map as necessary.