Joint replacement has been undergoing a revolution in recent years, and
Hoag Orthopedic Institute and its orthopedic surgeons are on the forefront
of that change, leading the way for same-day joint replacement surgery
since 2008. We spoke with James T. Caillouette, M.D., a founder of Hoag
Orthopedic Institute and renowned orthopedic surgeon who specializes in
hip and knee surgery, about the evolution of joint replacements and its
impact on patients’ recovery.
What is the difference between inpatient hospital and same-day joint replacement surgery?
A: For the majority of patients who undergo an elective procedure such
as a hip or knee replacement surgery, they would be admitted to a hospital,
and after joint replacement surgery, would spend up to a day or two in
the hospital recovering before being sent home or, if necessary, to a
step down facility to recuperate. Patients undergoing same-day surgery
could be admitted to a hospital or an ambulatory surgery center and then
be discharged less than 24 hours after their surgery. Years ago, when
I was an orthopedic surgery resident, for example, patients undergoing
joint replacement typically would spend up to seven days in the hospital
before going home. Today, I have patients that come in at 7 a.m. and are
up and walking after surgery ready to go home in the late afternoon. There
has been a revolutionary shift in the technique, anesthesia and process
of joint replacement surgery to shorten the length of stay in a hospital
or surgery center and return the patient home as soon as medically appropriate.
Is same-day joint replacement surgery available to anyone?
A: No. Patient selection for same-day joint replacement surgery is of paramount
importance. Ideally, younger patients that are in good overall health,
engaged and committed to their surgical journey and have a support system
at home while they recover can receive same-day joint replacement surgery.
Some older patients or those who have chronic health conditions such as
diabetes, certain heart ailments, COPD or have a high BMI (body mass index)
and don’t have a support system at home may not be candidates for
same-day joint replacement. If you are generally fit, younger and in good
general health, you are an ideal candidate for same-day surgery.
Are the results of same-day surgery the same?
A: Yes, and perhaps even better. There has been a lot of medical research
into the outcomes of same-day joint replacement surgery and the findings,
in general, are that patients fare better when they go home the day of
their joint replacement surgery. The studies found that same-day joint
replacement patients experience fewer complications, including a lower
infection rate. Moreover, patients themselves report a high degree of
satisfaction and better outcomes with their same-day surgery experience.
In most of our same-day surgery patients, we get them up and walking within
hours of their surgery. Motion is life.
How long have you been performing same-day joint replacement surgeries?
A: We did some of our first same-day surgeries more than a decade ago and
each year since then we’re doing more on a same-day basis. At Hoag
Orthopedic Institute (HOI), we helped pioneer the concept of “bundled”
payments for joint replacements. Under this scenario, companies pay one
set fee for the episode of care for their employees for joint replacement.
To save costs for the employer and patient, we began performing joint
replacements same day for those who met the criteria.
Does same-day surgery carry risks?
A: All surgeries carry some risk, and these risks should be discussed in
detail with your doctor. All in all, there is no additional risk by having
same-day surgery. However, some patients don’t like the idea of
being rushed home. Recovery can be taxing. Same-day surgery does not offer
the round-the-clock care for a few days that you would receive in a hospital
setting. The key is preparation: the more you can do before your surgery
to prepare for when you get home the better. Most importantly, you need
good at home support from a family member or caregiver to help you through
Why is same-day surgery a growing trend?
A: Innovations in the surgical approach to hip and knee replacements are
part of the drivers behind the trend. Couple this with newer and improved
anesthesia and pain management techniques as well as accelerated and customized
physical therapy regimens and the result is a revolution in joint replacement
surgery. To date, HOI has performed more than 1,000 same-day joint replacements.
Most experts predict that by 2027, 50 percent of all joint replacements
will be performed on a same-day basis in the U.S.
Why the rush to get the patient home quickly?
A: Hospitals, even the best ones like Hoag Orthopedic Institute, are not
the same as your home and your own bed. When we send patients home the
same day, they are already performing physical therapy through Hoag’s
Enhanced Recovery Program. Even with help, they are walking and putting
weight on their new knee or hip. At your own home, you are around your
own germs, so the risk of infection is reduced.
Does same-day surgery costs less?
A: Yes, but it really depends on your health insurance benefits. Same-day
joint replacement surgeries are typically less expensive than an inpatient
overnight hospital stay; moreover, having your surgery performed in an
outpatient surgery center may reduce the cost of the surgery significantly,
again, depending on your benefits.
What are the best criteria to review to determine if your surgeon is experienced
in same-day joint replacement surgery?
A: I would encourage you to ask about the surgeon’s and hospital’s
experience with same-day joint replacement surgery. Studies have indicated
that the more same-day joint replacement surgeries you perform, the better
your results. I would also ask if they collect and publish outcomes for
patients to review. You can review our results at
(James T. Caillouette, M.D., is the founding partner, Chief Strategy Officer
and The Joan and Andy Fimiano Endowed Chair in Orthopedic Surgery at Hoag