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Are You a Candidate for Same-Day Joint Replacement?

12-04-2019

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:

  1. 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.
  2. 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.
  3. 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.
  4. Patients who have a high BMI (body mass index) may not qualify for a same-day procedure.
  5. 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.

(Orthopedic surgeon 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.)

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