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Digital Issues

Archive >  March, 2014 XV, No. 3

Yes, You Can Do Same-Day Hips

A surgery center is doing 40-minute hip replacements and sending patients home in 3 hours with remarkable results.

Christopher McClellan, DO; and Dave Berkheimer, BSN, CRNA

expose the hip joint POPULAR AND PRACTICAL It's estimated that nearly 70% of orthopedic surgeons use the posterior approach to expose the hip joint for easy, safe and quick access to the joint.

We've performed 90 joint replacements since we launched our same-day total joint program at our ambulatory surgical center 2 years ago. Guess which group of patients has fared the best: knees, hips, shoulders or ankles? Our total hip arthroplasty patients, and it's not even close. Given hip replacement's reputation as a bloody procedure with a grueling recovery, we were surprised, too. But from surgical outcomes and discharge times to patient satisfaction scores and pain scores, the 30 hip cases we've done thus far have gone exceptionally well. The numbers speak for themselves.

  • Discharge. On average, our same-day total hip patients leave here about 3 hours after their surgeries (sometimes in a hospital a patient doesn't even get to his room 3 hours after surgery).
  • Pain. The average pain score on post-operative day zero is 1.3. Pain scores on days 1 and 2 are between 3 and 4 — and that's their pain scores after physical therapy, not their pain scores at rest.
  • Satisfaction. By replacing diseased hip joints with artificial joints, we are truly changing our patients' quality of life — relieving their pain, increasing their motion and helping them get back to enjoying many normal, everyday activities. This reminds us of the post-op patient who rather than use his walker to take his first steps with his new hip actually lifted the walker and began to walk away with it. We gently reminded him that the walker's wheels would help him get around. "No thanks," he told us. "I don't need any help."
  • Complications. We haven't seen more than 100cc of blood loss. We've had zero readmissions and revisions, and zero falls.

Outpatient total hips?
At first we were skeptical about the concept of hip replacement without a hospital stay. Discharging a patient in 3 hours who just underwent a bloody and painful surgery that usually requires 2, 3 or more days in a hospital is pretty ambitious. But the same-day joint replacement program here at Advanced Center for Surgery, one of the first of its kind on the East Coast, has exceeded our expectations and garnered national attention. We've found our success by focusing on the fundamentals: patient selection, tailored regional anesthesia, a posterior approach to surgery, physical therapy and home nursing care.

 
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