Archive Orthopedic Surgery 2018

The Inside Scoop on Same-Day Hip Success

Plenty of planning and a pushy patient helped me make the move to outpatient ORs.

Patrick Toy

Patrick Toy, MD

BIO

HEAD ON
HEAD ON Patrick Toy, MD, (center), says the anterior approach is one of the keys to outpatient hip replacement.

I'd been thinking about transitioning my total hips from inpatient to outpatient, but hadn't yet taken the leap when the bass fisherman walked into my clinic. He was quite blunt in telling me that he wasn't crazy about doctors and he certainly didn't want to spend a night in the hospital when he had his hip replaced. He was young and healthy, so I thought, "Why not?"

That decision, made back in 2013, was based on more than just the fact that I was confronted by an impatient patient. It was based on the positive results I'd been obtaining for years in inpatient ORs using an anterior approach.

I learned total hip replacement during my residency, using a posterior approach that kept patients in the hospital for at least 3 days. On the day after surgery, we removed the drain placed during the procedure. We changed the dressing the next day. On the third post-op day we referred the patient to an inpatient rehabilitation facility for 10 days to 2 weeks. These days, I reserve the posterior approach for those rare occasions when I need access to the back of the hip for technical reasons, such as removing previously placed implants from the posterior hip socket or acetabulum, or augmenting a deficient posterior wall of the acetabulum.

When I initially tried the anterior approach, I still kept patients in the hospital for 3 days, but I started noticing that they were more mobile soon after surgery, so I kept them hospitalized for only 2 days. Then I realized that some patients were ready to go home the day of surgery, which made me think: "Why am I doing this in the hospital? I have access to outpatient centers that have 23-hour observation and the capability to keep patients overnight."

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