Enhanced Recovery

Mr Wheelton is particularly interested in enhancing the recovery of his patients to optimise their experience and outcome. Through research and collaboration with other surgeons worldwide he has adapted his surgical techniques to reduce swelling post operatively with the aim of producing less pain while you are recovering by following evidence-based methods. He has engaged with and learned from a world-renowned specialist in America, Dr Andrew Wickline MD, who has patented ‘Less Swelling Less Pain’ guides for hip and knee replacement surgery and conducted research that shows significant reduced swelling post surgery, Mr Wheelton follows and recommends many of the techniques Dr Wickline has researched. This is cutting edge research and treatment regimes.

(https://doi.org/10.60118/001c.77444)

These include, for all patients:

• Walk, cycle, swim or cross train for 15minutes daily if pain allows
• During breakfast, lunch and dinner times do 10 calf raises and twenty march in place exercises
• Diaphragmatic breathing x3 episodes per day

(https://doi.org/10.10Tourniquets may increase complications in knee surgery - NIHR Evidence16/j.jvs.2003.09.036.

For knee replacement patients

• Mr Wheelton will very rarely inflate a tourniquet while performing knee replacement surgery. A tourniquet is a device like a blood pressure cuff which can be inflated to high pressure to reduce the amount of blood flowing to the knee during surgery. Tourniquets are used by many surgeons but increasing evidence suggests that their use can increase complications such as blood clots and can lead to more pain and swelling post operatively (Tourniquets may increase complications in knee surgery - NIHR Evidence)

• Mr Wheelton reduces the use of electrocautery to a minimum and aims to make surgical technique as atraumatic as possible. (https://doi.org/10.1007/s00264-018-4048-y.)
• Mr Wheelton aims to personalise the alignment of the knee replacement to each patient. This aims to reduce the amount of ‘releases’ of ligaments and tendons that are required during the surgery with reduced swelling and inflammation.
• Mr Wheelton uses barbed sutures to close the knee wound. These do not need to be removed and typically cause less irritation, pain and swelling than metallic clips which are used by many surgeons.
• Mr Wheelton leaves the knee in flexion in the recovery room which helps to reduce post operative bleeding and can reduce post operative swelling (https://doi.org/10.1186/s12891-021-04369-4)
• Mr Wheelton prescribes patients oral tranexamic acid for 5 days post-operatively as this has been shown to reduce bleeding and swelling and pain (https://doi.org/10.1016/j.arth.2024.02.0273)

For hip replacement patients

• Mr Wheelton uses a minimally invasive ‘direct superior’ STAR approach to reduce the surgical insult with the aim of reducing  post operative pain and swelling. The approach avoids cutting the iliotibial band which is an important structure in the leg which has important function in walking and running. By leaving this intact faster recovery is likely. He also preserves the piriformis tendon where possible which reduces the risk of dislocation and also helps with faster recovery and more normal gait.
• Following the same principles as described in the knee replacement section including oral tranexamic acid, barbed sutures and patient specific alignment.
  

Dr Andrew Wickline has created comprehensive hip and knee replacement patient recovery guides which Mr Wheelton advocates and are a very helpful resource for patients. These can be purchased @ Less Swelling Less Pain | Shop Dr. Wickline Hip & Knee Books