Outpatient Joint Replacement – Is It Right for You?

Why Should You Consider Outpatient Hip or Knee Replacement?

Joint Replacement is a relatively major surgery. Typically, patients spend 1-3 days in the hospital following the procedure to work with physical therapy and monitor for issues with pain. The hospital setting has been very successful, so why change something that works?

Patient Experience

The hospital is a busy, and sometimes, chaotic environment, and the many moving parts are not always directed towards your direct care. In the ambulatory setting, there is considerably more surgeon control over the care episode. The teams are smaller and highly specialized, translating to an efficient and more personalized experience. Most centers that perform outpatient total joint procedures are highly specialized for orthopedic care. Boston Out Patient Surgical Suites performs only orthopedic procedures, and as a result, everyone on the team has extensive experience and interest in your case.

For you, outpatient joint replacement will likely be a less stressful surgical experience….and this means a quicker recovery.

 

But What about the Risks?

Not all patients are appropriate candidates for outpatient surgery. Despite this, current projections estimate that 50% of total hip and knee replacements will be performed in outpatient facilities by 2027. This is directly related to improved pain control options, less invasive surgical techniques, and more diligent management of risk factors known to complicate surgery. Talk with your surgeon about whether outpatient joint replacement is right for you.

The key to success for the patient is appropriate consideration and preparation by your surgical team. A thorough history and exam will be supplemented by the standard preoperative work-up including: EKG, a complete metabolic panel, complete blood count, and HgbA1C in diabetics.

Preparation is Key

Unlike hospital-based surgery, a lot of the work when operating at an ambulatory surgery center is front-loaded, utilizing a multi-disciplinary team before the surgery. This means that you will have a well-defined plan for your post-surgery care before you even have the procedure.

You should select a family member or close friend to stay with you for the first 72 hours after you go home. Ideally, this person will attend your preoperative evaluations to better understand the plan after surgery.

Boston Out Patient Surgical Suites uses an Arthroplasty Navigator to streamline the process. You will be contacted by one of our patient navigators after scheduling your surgery. This will be a friendly and consistent contact, who with your surgeon, will help manage perioperative expectations, coordinate logistics on the day of surgery, and plan for home care.

A Physical Therapist will meet with you before surgery to discuss the therapy protocols and review your living situation. They will help you prepare for the mobility restrictions that are expected in the short-term after surgery.

Home Health Care will be coordinated to visit you at home. Their team will visit daily and includes nurses and physical therapists to make your first week at home more comfortable.

Schedule an Appointment

While outpatient joint replacement is not for everyone, if you have arthritis but remain healthy and active, the ambulatory experience may be for you. Talk to Dr. Schena or Dr. Werger today to see if you are a good candidate for the patient-centered care of Boston Out Patient Surgical Suites.

(617) 738-8642

 

Hip Arthroscopy: Choose Your Indications Carefully

 

Osteoarthritis by definition is loss of cartilage within a joint. The sequelae of this occurrence are progressive development of bone spurs and cysts, which further the symptoms of degeneration. Once bone-on-bone arthritis has set-in, there are no treatments to date that can restore lost cartilage and the lost joint space.

Hip Arthroscopy Indications

Hip arthroscopy was first performed in 1931, but its utility has been limited until recent advances in optics and instrumentation. Over the past decade or so, there has been a rapid increase in the proposed indications, and subsequently, in the number of providers offering this service.

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Going to the Dentist after Joint Replacement

The concern with dental work after joint replacement is a possibility of inducing infection. Bacteria from your mouth can enter your blood stream and settle onto your implant. Approximately 6-13% of total joint infections involve bacteria primarily found in your mouth. The highest rate of infection is within the first 2 years after surgery. While this does not directly mean that bacteria from the mouth cause joint infections, the association is strong and concerning if you happen to be unlucky!

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In 2003, the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) first published guidelines regarding antibiotic use for dental procedures following hip and knee replacement. These recommendations have been addressed twice by this joint panel since that time, with the latest publication in 2012 suggesting that the data is not strongly for or against antibiotics before dental work. Ultimately, the decision to use antibiotics for dental procedures should be made with consideration of each patient’s health and surgery.

When do we recommend antibiotics?

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Opioids…A Growing Epidemic

Last week, Tiger Woods was pulled over for driving under the influence…of opioid medications. He is not an IV drug user and he was not drunk behind the wheel. Instead, his judgement was clouded, at least in part, by very strong pain medications. His picture was plastered over every major news outlet, and for better or worse, he is becoming today’s face for an epidemic.

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A 2016 Washington Post/Kaiser Family Foundation survey found that 1 in 3 patients who took opioids for at least two months reported feeling addicted or dependent on the drugs. In addition, patients taking opioids prior to surgery have greater post-surgical pain, and face a higher risk of pneumonia, over-sedation and even death. It is not uncommon to have post-surgical patients report they felt symptoms of “withdrawal” after they stopped taking their pain medications only a few weeks following surgery.

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According to the U.S. Department of Health and Human Services, more people died from drug overdoses in 2014 than in any year on record, and the majority of drug overdose deaths (more than six out of ten) involved an opioid. Since 1999, the rate of overdose deaths involving opioids (including prescription pain relievers and heroin) nearly quadrupled. On an average day in the U.S., more than 650,000 opioid prescriptions are dispensed, 3,900 people initiate nonmedical use of prescription opioids, and 78 people die from an opioid-related overdose. According to the CDC, in 2015 alone, more than 22,000 people died from prescription opioid overdoses, and countless more have had their lives influenced by dependence.

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Can You Be Allergic to Your Hip or Knee?

What is Metal Sensitivity?

Metal sensitivity (or metal hypersensitivity) is an allergic reaction triggered by the body’s immune system. Unlike the clear and immediate reaction one might experience to pollen and dust, allergies to metal present in a more delayed fashion. Basically, your body develops a negative memory regarding a specific antigen (i.e. metal) and overreacts when that metal shows up again. It’s not usually an immediate response like a bee sting, but rather, it can take several days or more before the signs begin to appear.

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How Long Will My Hip Replacement Last?

A common question we as surgeons, and you as the consumer, are faced with is: “How long will my hip replacement last?” It’s easy to rattle off a number, but the reality is not so cut-and-dry.

According to CDC data, in 2010 alone >310,000 hip replacements were performed in patients age 45 and older. Recent projections expect that number may reach almost 600,000 by 2030. We are seeing a significant increase in hip replacements for younger patients. From 2000-2010, the population with the largest volume increase was age 45-54. Additionally, by 2010, hip replacements in patients age 55-64 accounted for a higher percentage than those >75.

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SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000 and 2010.

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Does Approach Matter for Hip Replacement?

In the past few years, there has been a debate among physicians and patients regarding the “optimal” approach for hip replacement. If fact, considerable marketing has been deployed to attract patients to a surgical approach, citing rapid recovery, minimal or no pain, muscle-sparing exposure, and return to unrestricted activity. The frank reality is that these outcomes are possible with almost any of the common approaches today. The American Academy of Hip and Knee Surgeons (AAHKS), which is the largest collection of fellowship-trained specialists in total joint replacement, has concluded that “the best approach is the one your doctor is most comfortable with to allow safe and precise implantation of your hip replacement components.” As a patient, you should choose the surgeon and trust on their decision regarding the approach.

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