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Increasingly younger patients are seeking partial or total hip or knee joint replacement—people in their 40s, 50s and 60s who are working and active and who can’t afford to slow down. As such, researchers expect a 77 percent growth in joint replacements over the next decade. These patients may have a surgical option previous generations never had before: outpatient joint replacement surgery. These advanced procedures allow patients to go home in as little as 24 hours after surgery.
Patients who are good candidates for outpatient joint replacement surgery are those who:
- Are healthy and active
- Are non-smokers
- Have a low body mass index (BMI)
- Have a good support system at home
It’s crucial that patients who go home the same day as their joint replacement surgeries have a robust support system at home—a friend or family member who can care for them so patients can enjoy all the benefits of outpatient techniques.
Many patients come to us who have been turned away from other centers. A lot of patients who come to us either have significant joint deformities or they’ve had several procedures that have been unsuccessful in the past. We evaluate them to provide a more stable functional prosthesis. We will frequently see those patients at our institutions because we use a personalized team approach that includes care at every step along the way—before, during and after their surgeries.
LISTEN: Orthopedic surgeon Savyasachi Thakkar discusses same-day joint replacements in the Medical Intel podcast.
What are the benefits of outpatient joint replacement?
One of the biggest benefits for patients is to recover in the comfort of their own home. We make this possible by collaborating with social workers called the post-acute care (PAC) coordinators. These experts address all of a patient’s needs before, during and after surgery. This includes home-based physical therapy for two weeks after surgery, which has several benefits for patients:
- Better pain levels without ongoing in-hospital vitals checks
- Cleaner, better-controlled environment
- Fewer falls after surgery
- No need to arrange transportation to physical therapy
For all of these reasons, outpatient joint replacement recovery often is healthier, quicker and much more effective than recovery after inpatient surgery.
Recovery after same-day #jointreplacement often is healthier, quicker and much more effective than recovery after inpatient surgery. bit.ly/2Nqoekz via @MedStarWHC
We saw an energetic individual who clearly demonstrated a need and desire to get back to her active lifestyle. She needed a knee replacement surgery to do that. We brought her in for surgery and performed the operation without any complications. In fact, she was so ecstatic with her mobility and pain control that she was eager to leave the very same day.
How do outpatient and traditional joint replacements compare?
The actual surgical procedure is similar for both traditional and outpatient joint replacements. The main difference for patients who undergo traditional surgery is that rehabilitation occurs in the hospital, not at home. Inpatient rehab patients may experience:
- Higher pain scores because they’re not in their normal home environment
- Increased cost for the hospital stay
- Longer rehabilitation times
joint replacements make sense for some patients who are elderly and more fragile, who don’t have support systems at home and who are less active. But for more active, younger patients, we think that outpatient procedures are the way to go.
Frequently asked questions about outpatient joint replacement
How long is the recovery process?
For a younger, more active individual, recovery could be as quick as three or four weeks. For an elderly patient, it could be about seven to eight weeks. Many patients who have had these outpatient procedures are raring to go back to work after six weeks. We are starting to see a larger proportion of patients who want to get away from the distraction of having surgery and reduce their pain by going back to work sooner.
Is it possible to completely return to normal after surgery?
Absolutely! Joint deterioration happens over a long time, though it might cause noticeable symptoms only for a few months or a few years. Joint deterioration is associated with several other problems, such as loss of muscle mass and inability to perform or enjoy daily living activities. Those things take about three or four months to get back to normal. Our team of specialists work together to minimize pain as much as possible, and for the most part, when patients are pain-free after surgery, they experience such relief that they are able to tackle life at a much faster pace.
Related reading: Am I too young for knee or hip replacement?
What are the advantages of a team-based approach?
We have several specialists devoted to patients who need joint replacements. The team treats about 1,000 patients each year at MedStar Washington Hospital Center, from simple hip and knee replacements to complex surgical revisions:
- Dr. James Tozzi and Dr. Savyasachi Thakkar perform primary and revision hip and knee replacement surgeries
- Dr. Wiemi Douoguih and Dr. David Johnson perform primary knee replacement surgeries
- Physical therapists evaluate patients before surgery, immediately after surgery and then six to eight weeks after surgery on a continual basis
- Social workers exclusively care for patients having knee and hip replacement surgeries who also have complex medical needs and complex social situations
- Specialized nurses are devoted to patients on our orthopedic floors
We are a tertiary care facility, which means our patients also have streamlined access to other specialists, such as neurosurgeons, cardiac surgeons and other various doctors and specialists, so that any potential complications can be addressed easily. Also, if a patient we initially planned on leaving the same day ends up needing to stay in the hospital for a night or two, it’s easier to transition the patient. This is in contrast to numerous surgery centers that are popping up across our communities, where they do not have such facilities or expertise.
5 areas of upcoming research in total joint replacement
Joint replacements have come a long way, especially during the last decade, but there’s still room to grow. We are focusing on several areas of research for joint replacement patients:
- Improved patient outcomes through best practices and procedures that focus on safety and reduced readmissions.
- Pain management research so we can deliver different kinds of therapies at the same time.
- Pre- and postoperative nerve ablation, which is the blocking of pain signals from nerves using radiofrequency ablation to remove the skin nerves around the incision sites of the surgery, reducing pain.
- Robotics or computer-assisted navigation to help us reduce operative time, blood loss and the need for blood transfusion. We’re calling this “bloodless surgery” because we can avoid significant blood loss, reduce the risk of blood clots and perform the procedures safely without the risks involved with blood transfusion.
- Alternative bearing surfaces, in which we cap the bones with different materials that help form the new joint. Alternative bearing surfaces can give patients better pain control, better mobility and longer-lasting joint replacements.
We think most patients are shocked at first by the notion of having a joint replacement surgery and leaving the hospital the same day. They are often nervous about the idea, but when they look at our pain control strategies and how we have organized treatment for them, most patients wake up after the surgery remarkably happy and satisfied. They go home feeling comfortable that they can call us anytime and someone will be available to answer their questions, ease their fears and help them transition back to a more active lifestyle.