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Ten patients, two theatres, one lead surgeon. 

With demand meaning some patients had waited up to 45 weeks for a joint replacement, we knew we needed to take action to get them the treatment they needed.

Our innovative team, led by experienced orthopaedic surgeon Shivakumar Shankar, came up with HULK-10 – which stands for hip, unicompartmental (partial) and knee, the operations they carried out.

On Thursday 22 October, they completed five hip and four knee replacements, as well as one partial knee replacement. Shivakumar led all 10, swapping between theatres, supported by an assistant surgeon in each theatre.

He said:

We’ve not done anything like this before, I’m not sure if anyone has. Efficiency was key.

When I was three quarters through one operation, our anaesthetists would begin preparing the next patient. I would finish the current joint replacement, then my assisting surgeon would close the wound while I moved to the theatre next door to start another procedure. We have lots of patients waiting and I wanted us to push ourselves to safely maximise the work we could do in one day. I’m immensely grateful to everyone involved, it was a true multidisciplinary achievement.

The operations were carried out at our Elective Surgical Hub at King George Hospital (pictured below are members of our team in theatre).

Shivakumar, who has been at our Trust for 10 years and completed some of his training with us in 2012, added:

I’m really happy with how it went. The planning was hugely important to ensure everything could be executed. I’ve been operating for many years now, but I still had butterflies hoping everything would go to plan.

Our aim is never to rush surgery, but to eliminate avoidable delays and maximise efficiency while providing high quality, safe, care to every patient. I went to check on them afterwards, they were recovering well and it was nice to see happy, smiley faces. Now they’ve had their operations they can regain mobility and get on with their lives.

Just before HULK-10, we held an ACL (anterior cruciate ligament) week at our surgical hub, completing 14 knee ligament surgeries in just six days.

Roxy Dinka, Patient Pathway Manager, said:

In an average week we’d usually do just one or two of these, so it took six weeks of planning to ensure we could treat this many patients. One had waited 48 weeks, so we really wanted to prioritise getting them, and others who’d had long waits, treated. When one operation overran, we added an additional twilight session to ensure no one was cancelled.

Most of the patients were able to go home on the same day. This will make a real difference to their lives.

Since the pandemic our teams have used a number of innovations to help reduce our waiting lists, including ‘Bones’ weeks, carrying out high numbers of operations in shorter times scales than normal.

In the past, these initiatives have focused on high volume, low complexity operations. In contrast, HULK-10 also treated patients who needed more complex procedures, and had often experienced long waits.

Pictured top are members of the team who carried out these operations.