Imagine having hip replacement surgery in the morning, walking on your
new hip shortly thereafter and then sleeping in your own bed the same
evening. That scenario is not a pipedream, but a reality for many patients
today, thanks to innovations in the approach to joint replacement surgery.
Over the last several years, there has been a revolutionary shift in the
surgical 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, often the same day.
Experts predict that by the year 2026, about half of all hip and knee
joint replacements done in the U.S. will be done on a same-day basis.
But same-day joint replacement is not for everyone. In our experience at
Hoag Orthopedic Institute in Irvine, patient selection is the key to ensuring
a high quality, safe and successful outcome. The criteria we use to decide
if a patient is a candidate for same day surgery:
- Younger patients who are in good overall health, engaged and committed
to their surgical journey and have a support system at home are ideal
same-day surgery patients.
- Older patients who may have limited mobility or other medical issues are
typically performed on an inpatient basis and don’t meet the rigorous
criteria for same-day surgery.
- Those who have chronic health conditions such as diabetes, certain heart
ailments and COPD and don’t have a support system at home may not
be candidates for same-day joint replacement.
- Patients who have a high BMI (body mass index) may not qualify for a same-day
- Only your orthopedic surgeon can determine if you are a candidate for same-day
joint replacement surgery.
A lot of my patients ask me if same-day joint replacement surgery provides
the same success rate as inpatient joint replacement. 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. I believe when a patient recovers at
home verses a hospital bed, they are among their own germs and more comfortable,
which may benefit recovery. 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.
Some patients have their same-day surgery in a free-standing outpatient
surgery center, which is separate from a hospital. Others can have their
same-day surgery in a hospital but are then sent home the same day; having
your joint replacement surgery in the hospital offers back up services
and expertise available should there be a complication. It could also
allow the surgeon to keep the patient overnight to ensure a better outcome.
Others have their surgery as an inpatient in the hospital, staying overnight
or several days depending on their recovery. At Hoag Orthopedic Institute,
for example, we offer patients all three options, a design in the delivery
of health care that was purposeful to benefit all patients.
Today, there many hospitals that offer same-day joint replacement surgery.
While HOI has been doing outpatient joint replacement for more than a
decade, some hospitals are just beginning to offer this option for their
patients. In fact, if you have heard about “Nano” knee, it
is an outpatient option for knee replacement surgery. There is no new
knee implant called a “nano knee” or the name of a new surgical
technique. “Nano” knee is a creative marketing term that is
used by a medical group to advertise outpatient knee replacement surgery
in a free-standing outpatient surgery center and the rehabilitation program
that supports it.
There are lots of things to consider when faced with the decision of having
joint replacement surgery, including if you can have your surgery on an
outpatient basis. 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. Do your homework and ask
questions to ensure you are making an informed decision about your health.
Alan Beyer, M.D., is executive medical director of Hoag Orthopedic Institute in Irvine
and is host of “Doctor in the Dugout,” a weekly live sports medicine radio show on KLAA AM.)