Outpatient Joint Replacement: Our Study Looks at Trends and Safety

Outpatient hip and knee replacements are on the rise. Yes, increasing numbers of patients are going home the same day they have joint replacement surgery. We launched a study at Hospital for Special Surgery (HSS) to see if patients who went home the same day did as well as those who spent one or more nights in the hospital.

Analyzing information from a large database that included patients nationwide, we found no significant difference in complication rates for outpatient hip replacement. For knee replacement, we found slightly higher odds of complications in patients who left the hospital on the day they had surgery. Overall, though, complications were not common in either knee replacement group, with an incidence of less than 1%. The study appeared online in The Journal of Arthroplasty.

For our study, we were able to identify almost 1.8 million patients who underwent an elective total hip or total knee replacement between 2010 and 2017. We found that the annual rate of outpatient hip replacement and outpatient knee replacement increased exponentially from 2010 to 2017, with a mean annual change of almost 16% in the hip replacement group and 11% in the outpatient knee replacement group. Overall, patients discharged on the day they had surgery were younger and healthier, with fewer medical conditions such as diabetes and chronic pulmonary disease.


Good general health is essential for anyone considering outpatient joint replacement. People who have heart or lung disease, diabetes or sleep apnea would not qualify. They should be nonsmokers. Younger patients in their 40s or 50s and 60s tend to be better candidates, but people in their early 70s in very good general health may also qualify.

Individuals considering same-day discharge should feel comfortable forgoing a night in the hospital where they would receive nursing care. Anyone who feels very anxious about surgery or experiences a great deal of stress about recovery may not be a good candidate.

Our study concluded that same-day discharge joint replacement is safe, but requires additional patient monitoring in the early postoperative period. And although outpatient joint replacement can be performed safety and efficiently, it’s an option, not a requirement. Every patient is different, and individuals and their doctors should make an informed decision based on what makes patients feel most comfortable.

Comments

Post a Comment

Popular posts from this blog

“Dual Mobility” Hip Replacement Does Double Duty: Relieves Pain and Reduces Risk of Dislocation

Image
Hip replacement to relieve arthritis pain is considered one of the most effective surgeries in the United States. Over the past decade, improvements in surgical technique, implant design, anesthesia and pain control after surgery have contributed to its success, says Geoffrey Westrich, MD, an orthopedic surgeon at Hospital for Special Surgery (HSS).  More than 450,000 total hip replacements are performed each year in the United States, according to the Agency for Healthcare Research and Quality. One of the most noteworthy advances is what’s known as a “dual mobility” hip replacement, according to Dr. Westrich, who has conducted several studies on the implant. He and colleagues have found that the dual mobility prosthesis reduces the risk of dislocation, one of the most common complications after hip replacement surgery. While the incidence is less than 2% at Hospital for Special Surgery and other major joint replacement centers, it is significantly higher at some other locations....
Read more

Did Halting In-Person Visits During Covid-19 Affect Knee Replacement Outcomes at Hospital for Special Surgery?

Image
At Hospital for Special Surgery (HSS), we set out to evaluate outcomes for recent knee replacement patients when nonessential in-person doctor visits and physical therapy were halted in March 2020 due to the pandemic. Our thought-provoking study found that the shutdown did not lead to a higher complication rate, nor did it affect patient-reported outcomes after surgery. Our study appeared online ahead of print in the Archives of Orthopaedic and Trauma Surgery . Elective, nonessential orthopedic care, including in-person office visits and physical therapy, was halted on March 16, 2020 at the onset of the COVID-19 surge in New York City. At that time, HSS rapidly expanded its telehealth and tele-rehabilitation services so patients could receive their care remotely, including post-operative visits and physical therapy.  Our study aimed to assess complications during the first 90 days following surgery and patient-reported outcomes within one year of surgery. We identified 624 patients...
Read more

Our Study at HSS Finds Knee Replacement with Robotic Assistance Leads to Lower Complication Rate

Image
These days you hear a lot about the use of robotics in joint replacement and other surgical procedures. Many orthopedic surgeons who perform robot-assisted surgery find that it improves the accuracy and predictability of a knee or hip replacement.  Indeed, the use of computer-assisted navigation and robotic assistance for total knee replacement has grown tremendously over the past few years and shows no sign of slowing down. Among American Association of Hip and Knee Surgeons attending the 2020 annual meeting, 77% of respondents indicated that they used technology in their surgical cases. The most common reason they cited was to increase surgical precision. A large study we undertook at Hospital for Special Surgery (HSS) found another major advantage of using a robot. Accessing and analyzing a huge national database with information on more than one million knee replacement patients, we found that surgery performed with robotic assistance led to a lower complication rate in the fir...
Read more