By Maurice Cates and Ryan Basen
Two decades ago, patients typically stayed 11 days after undergoing knee and hip replacements, usually in inpatient settings. They rested in the hospital, recuperated in a rehab center and often suffered complications due to inactivity.
Now, outpatient care allows patients to go home after passing required tests—walking up and down stairs and using the bathroom unassisted—within 24 hours after surgery. Using new technology and techniques, we can mobilize patients and send them home quickly, which minimizes complications and accelerates recovery.
Patients who qualify should consider undergoing these increasingly popular joint replacements in outpatient ambulatory surgery centers.
And more patients should qualify: These procedures are among the fastest-growing in the nation as baby boomers age, rising obesity rates cause more joints to be overstressed and people want to maintain active lifestyles. Between 1993 and 2009, the volume of total knee replacements tripled, and total hip replacements nearly doubled in the U.S. for inpatient surgery alone. One of every 25 people over 50 now live with a replaced knee, with rates especially surging among people ages 45-64.
These rates are also increasing because total knee and hip replacements are among the most effective and safe medical procedures. They radically enhance patients’ lives and rarely trigger complications or poor results, particularly in outpatient settings. In fact, outpatient knee replacements have become more popular since at least as far back as 2012.
But that same year, just 9.7 percent of knee replacements and 2.9 percent of hip replacements conducted at hospitals were done in designated outpatient settings. There’s a discrepancy between perception and reality. Many patients still think they need to stay in the hospital after surgery and become anxious when they hear other patients are staying while they may be going home. Hospitals typically begin rehabilitation on-site and enroll patients in physical therapy at an inpatient rehab or skilled nursing facility. The average patient now spends four to five days away from home after undergoing surgery at a hospital.
By contrast, every patient who meets criteria for surgery at a freestanding outpatient center is home within 24 hours. My practice, Mid-Atlantic Permanente Medical Group, discharges vetted outpatient candidates the same day or the day after surgery. That’s because outpatient teams address potential obstacles before surgery by screening to ensure patients have no other serious health problems (such as diabetes or heart disease) and consulting with anesthesiologists. After surgery, we manage pain by following research-supported protocols and encouraging early walking.
This is important because you are more likely to avoid complications when you get up to move around soon after surgery and start rehab at home. People are more comfortable at home, where they can partake in home-based physical therapy or telerehabilitation and avoid complications such as blood clots and infections that sometimes arise during hospitalization. Home rehab has generated comparable results to in-person rehab.
Home rehab also lowers costs. And because hospital care and post-acute care constitute about three-quarters of knee and hip replacements costs, undergoing the surgery outpatient will help address what researchers call a “large public health burden.”
My practice began conducting full knee and hip replacements in outpatient centers earlier this year. This is value-based, high-quality care that more patients should explore.
A board-certified orthopaedic surgeon, Maurice Cates M.D. is regional medical director of musculoskeletal services for Mid-Atlantic Permanente Medical Group (MAPMG) and its orthopaedic surgery practice, which spans the Washington, D.C., area. Ryan Basen is a writer with MAPMG.