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Orthopaedic & Rehabilitation Institute

Joint Replacement

Joint Replacement Patients Could Soon Have Surgery, Go Home On the Same Day

The prognosis for hospital stays for patients undergoing total knee or hip replacement surgery is nothing short of amazing. What used to be considered major surgery for many patients has now been minimized considerably, thanks to advances in surgical techniques and pain management.

It wasn’t that long ago that a patient entering the hospital for joint replacement surgery could expect a seven to 10 day stay followed by months of recovery and therapy before returning to a normal lifestyle. But advances in the methods of cementing and fixation for both knees and hips that focus on new techniques with smaller incisions have led to shorter stays with better outcomes. More recent advances in pain management have lessened the stay even more. On the horizon for the very near future is the potential for patients to go home the same day they have surgery for these once debilitating surgeries.

“There is a big push to control pain and complications so we can do same-day surgery in the near future,” said Nicholas Sotereanos, MD, Director of Adult Reconstructive Surgery at Allegheny General Hospital. “We will be able to do this in a safe way that reduces the likelihood of complications so patients are safe to go home more quickly.”

One of the biggest obstacles to a shorter turnaround time in the hospital is the administration of anesthesia to patients who are otherwise healthy and strong.

“Patients are staying longer not because they can’t use their knees or hips to get around, but because of neurological issues and side effects from the anesthesia and pain medications that keep them from feeling well enough to go home,” noted Dr. Sotereanos. “Many of our patients should be able to go home the same day.”

Changes in the way anesthesia and pain medication are being administered will make this goal a reality in the not-too-distant future. Traditionally, general anesthesia has been administered in joint replacement candidates, meaning anesthetic agents enter the bloodstream and are dispersed throughout the nervous system. Since the anesthesia affects the entire body, the patient loses consciousness and often experiences nausea, vomiting, drowsiness and weakness for several days after surgery.

Regional anesthesia is now being administered using a catheter placed in the femoral nerve, which is close to the location of the hips and knees. The anesthesia numbs only a small part of the body and blocks pain for several hours after the surgery. Additional medications may be prescribed to control pain, but the likelihood of complications and side effects typical for general anesthesia are greatly reduced.

Because patients are more alert and in less pain, they often tolerate physical therapy more quickly and are prepared to leave the hospital sooner than those who feel sick and weak from general anesthesia.

This is good news for the increasing number of individuals who are expected to undergo total hip or knee replacements in the coming years as the active baby boomer generation reaches older age. Currently, there are approximately 200,000 arthroplasties performed each year. That number is expected to double in 2011 and could balloon to as many as 4 million in the next several years, according to Dr. Sotereanos.

“We are readjusting our mindset so we can provide better care for every baby boomer who will need these procedures in the future,” explained Dr. Sotereanos. “The goal is to make the surgery safe while controlling the pain so that patients can avoid long stays in the hospital.”

Also new in total joint replacement surgery is an increased emphasis on the comfort of the patient, who normally is not sick but must spend time in a traditional hospital setting. It is this realization that is the impetus for a new approach to patient accommodations at Forbes Hospital.

“We have set up a special unit where spine and joint patients are isolated from other patients at the hospital,” explained Michael Levine, MD, Chair of Orthopaedic Surgery at Forbes Hospital. “These are healthy people who are looking to get back to their healthy lifestyle quickly. They are not used to being sick and need an environment that doesn’t feel like a hospital so they can get back on the road to recovery.”

The new unit features upgraded rooms with plasma televisions and photos on the walls of people doing a variety of activities. In this home-like environment, patients share rooms with others who are experiencing the same sort of recovery so they are more apt to feel better and be more motivated to go home quicker. And by staying in a special unit, the infection rate for these otherwise healthy patients is decreased because they are not exposed to sicker patients.

Patients are also treated differently on the unit. Similar to rehabilitation hospital settings, patients are encouraged to discard traditional hospital gowns and to wear street clothes as inpatients. Plans are in the works to offer a concierge service to ensure patient needs are met, such as meal arrangements or special visits. This service will include access to a patient advocate who will work with patients to maximize their hospital environment to promote healing and their return home.

“We don’t want this to feel like a hospital,” explained Dr. Levine. “We want the unit to be a road to recovery where patients are in training to get back to life.”

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