Turning Total Joint Replacements Into Same-Day Procedures

Many people are better off recovering at home after surgery. They don’t benefit from the hands-on monitoring they receive in the hospital. They jump-start their recovery by getting out of bed and moving around more when they’re home. They’re more comfortable too — who doesn’t prefer sleeping in their own bed?

That’s why WellSpan Health began offering same-day discharge on total knee and hip replacements in 2018. About 25%-30% of our total joint patients prove eligible, and they usually go home within 8 hours of coming into the facility.

In the Q&A below, Dexter Bateman, MD, a fellowship-trained orthopedic surgeon and total joint specialist, answers the most common questions about same-day total joint replacements.

What Makes Same-Day Discharge Possible for Hip and Knee Replacements?

Orthopedic surgery has come a long way in the last 10 years. Advancements in technology and technique make total joint replacements far less invasive and much easier for patients to tolerate than before. For example:

• Anesthetic techniques like regional nerve blocks and periarticular injections lead to less postoperative nausea and drowsiness than general anesthesia. Patients can get on their feet sooner.
• Innovative surgical techniques can reduce trauma to soft tissue, which reduces pain, immobility and recovery time. For hip replacements, I use a direct anterior approach that allows me to insert instruments between the muscle groups rather than cutting them. For knee replacements, we often use robotics that offer increased precision.

What Eligibility Factors Should I Be Aware of When Talking to Patients About This?

Patients eligible for same-day discharge tend to be under age 70 with less advanced arthritis and well-controlled comorbidities, which reduces the risk of complications. These patients are generally healthier and more mobile to begin with.

We still recommend inpatient stays for patients with significant comorbidities like heart or lung issues. The extra monitoring and care they receive in the hospital is worth it in those cases.

How Do You Determine Which Patients Are Eligible?

We follow a rigorous process to determine the right path for every patient, including:

• Medical optimization, during which we measure BMI, smoking status, nutrition, A1C levels and other factors that affect a patient’s recovery and risk for complications. We often partner with PCPs on doing these tests and recommending lifestyle changes or clinical interventions that will help their patient during and after surgery.
• “Prehab” consultation with a physical therapist (PT): Patients fill out questionnaires and do functional testing with our in-house PTs. Our PTs also learn about the patient’s home environment and social supprt options — huge factors in whether a patient can safely recover at home.

How Do You Prepare Patients to Recover at Home?

We want the same thing the patient wants: To know that they will be able to move around and do daily tasks while their knee or hip heals.

That’s why every patient does postoperative functional testing with a PT or occupational therapist. This testing may include gait training with a walker, getting in and out of bed or a chair, going up and down stairs, and getting in and out of a model car.

Prior to discharge, patients may practice going up and down stairs, performing tasks in a model kitchen, and getting in and out of a model car.

Of course, many patients have questions after they get home, and we provide a dedicated point of contact to help them. Every patient is assigned a total joint coordinator whose full-time job is to manage the patient’s care throughout the process. All of our coordinators have clinical backgrounds, so they can field common questions about pain and activity levels and determine whether a patient needs to talk to their surgeon again.

How Do I Refer a Patient and What Happens Next?

We offer same-day total joint replacements in several hospital locations, including York, Chambersburg, Gettysburg, Hanover, Ephrata and Lebanon.

You can refer a patient via the contact information below. Within a few days, we will contact the patient to set their first appointment.

We discuss all new and current patients in a biweekly conference that includes orthopedic surgeons, PTs, social workers and more. Patients who aren’t eligible for surgery may be good candidates for PT, injections or other interventions. Those who are eligible will be scheduled for same-day or inpatient procedures. Patients eligible for same-day discharge can usually have surgery 4 to 6 weeks after their first appointment with us.

Turning Total Joint Replacements Into Same-Day Procedures

Same-day discharge can jumpstart recovery for eligible patients with knee or hip replacements. Learn eligibility factors to look for and how we ensure patients can recover safely from home.