Title : Doing more with the same: High-intensity hip arthroplasty lists at a ring-fenced elective orthopaedic centre
Abstract:
Background: Elective orthopaedic waiting lists remain a major NHS challenge, requiring models that increase surgical capacity without compromising safety. High-Intensity Theatre lists aim to reduce non-operative time, standardise peri-operative workflows and maximise throughput for high-volume procedures. We evaluated the implementation of High-Intensity Theatre lists and day-case total hip arthroplasty at a ring-fenced barn-style elective orthopaedic centre.
Methods: A prospective quality improvement project was undertaken using a PDSA framework. Data was collected for patients undergoing total hip arthroplasty across 12 High-Intensity Theatre lists. The pathway included pre-operative optimisation, standardised case selection, dedicated theatre teams, procedure-specific equipment, parallel processing, protocol-driven handovers, multimodal analgesia, early mobilisation and criteria-led discharge. Outcomes included throughput, turnaround time, length of stay, day-case discharge, complications, readmissions and multidisciplinary team feedback.
Results: 77 patients underwent total hip arthroplasty across 12 High-Intensity Theatre lists. Mean age was 70 years, mean BMI was 29 kg/m2 and 74% were ASA grade 2. Surgical throughput increased from 1-2 to 3-4 cases per session, representing a 50-60% increase in capacity. Mean turnaround time reduced from 50-60 minutes to 23.5 minutes. Mean length of stay was 1 day. 18 patients were discharged on the day of surgery, 48 on Day 1, 9 on Day 2 and 2 on Day 3. There were no post-operative complications and no readmissions in the day-case cohort. Three patients attended the emergency department with non-surgical medical issues. Early mobilisation was achieved within 2-4 hours, and post-list debriefs demonstrated high team satisfaction.
Conclusion: High-Intensity Theatre lists combined with a day-case hip arthroplasty pathway increased operative capacity by 50-60% while maintaining safety. This ring-fenced barn-style elective centre model reduced turnaround times, enabled early mobilisation and supported safe same-day discharge. It provides a scalable, GIRFT-aligned approach to elective recovery across NHS orthopaedic services.
