Joint replacement surgery has made great strides in the last decade. Many more patients go home and are walking around sooner thanks to rapid recovery joint replacement surgery.
Keys to a successful procedure are patient education, minimally invasive surgery, advanced pain-control techniques, and strong follow-up care.
Joint replacement has come a long way in a relatively short period of time. Ten to 15 years ago, a patient getting a new hip or knee would have spent four to seven days in the hospital before being released. Five to 10 years ago, it would have been one to two days. Now, physicians who are on the forefront of rapid recovery joint replacement can often have patients out of the hospital or surgical center the same day the procedure takes place.
“It’s about getting people ready for surgery, doing the surgery and then getting them recovered immediately afterwards so they can go home and sleep in their own beds and be with their family within a few hours of the procedure,” says Aric Christal, MD, an orthopedic surgeon at Swedish Orthopedic Institute, Edmonds Orthopedic Center and Proliance Surgeons.
Preparation is integral to the success of a rapid recovery joint replacement surgery. Dr. Christal says that over the years, physicians have recognized the importance of patient education. In fact, it is one of the major reasons why people are able to move so quickly to outpatient care.
“Traditionally, patients were not optimally educated going into these surgeries,” he says. “They were told to show up and would not know what to expect. A lot of the patient education came as a result of talking beforehand with friends and family who might have been through the procedure. For us, we try really hard to focus on patient education. We give people a book so they can read up on what’s going to happen and what to expect. We have pre-op classes and seminars that are taught by physicians, and there is also a Q-and-A session. Patients also see their physical therapist once before the surgery to learn about what exercises they need to do. When people come into the surgery, we ask if they have any questions, and more often than not, they say, ‘No, this is exactly what you said was going to happen.’ It decreases anxiety. They know they are going to get up, have something to eat and then walk.”
Patients also need to prepare in advance so that everything is ready once they come home from the joint replacement surgery. That includes making sure they have a caregiver lined up who will be engaged, knowledgeable and ready to help. The house should be put in order, and medications filled ahead of time so that patients don’t have to make a post-op trip to the pharmacy.
Rapid recovery joint replacement has also become more common due to advances in the procedure itself. Dr. Christal says the key is performing minimally invasive surgery with the least amount of soft tissue trauma, while minimizing surgical time. There are also certain surgical techniques involving pain blocks and pain catheters that can be used to mitigate pain. “After surgery, instead of waking up and feeling like they’ve been hit by a Mack truck, which is how things were not too long ago, now people wake up and ask, ‘Did I have the surgery? I don’t feel anything; nothing hurts,’” he says. “That allows them to get up and get out of bed immediately.”
That kind of mobilization is crucial in rapid recovery joint replacement. The evolution of pain-control techniques, coupled with minimal use of general anesthesia, allow patients to wake up faster, with a clear head and without nausea. They can be up and out of bed within an hour of the surgery. That, in turn, can help mitigate joint swelling, pain and stiffness, and reduce the incidence of blood clots.
“We get people up walking right away to show them that they can do it, to instill confidence,” Dr. Christal says. “Frankly, at that point most people want to walk out the door and go home.”
Once patients are at home, Dr. Christal and his colleagues like to maintain communication with them. They touch base with patients multiple times within the first few days to answer questions and make sure they are doing OK, and let patients know the physicians are available at any time should concerns arise.
If you are looking into joint replacement and want to be back on your feet quickly, Dr. Christal recommends asking prospective surgeons if they perform outpatient procedures, whether they have a facility and team focused on outpatient joint replacements, and how many of these surgeries they have performed. Swedish was named among the top 100 medical centers in the United States for orthopedic care by Becker’s Hospital Review and in the top 50 for orthopedic surgery by CareChex. Swedish Edmonds is also designated a center of distinction for hip and knee replacement by Blue Cross/Blue Shield.
He adds that any kind of joint replacement — be it shoulder, knee or hip — has the potential for rapid recovery, but not every patient is a candidate. “This is something that is considered for healthier individuals, who also have a strong support system and safe home environment to go back to, and who demonstrate they are motivated,” he says. “Our older, sicker patients with medical problems who may need observation overnight or do not have a good home situation are not candidates, and we identify them early on and tell them the reasons why we want to watch them overnight.”
For the ideal patient, the ability to go home sooner can make a huge difference. “In general, they recover faster and have fewer complications such as infections,” Dr. Christal says. “For the well-selected patient, going home sooner is almost always a good thing.”
To learn more about rapid recovery joint replacement or to make an appointment with a physician, contact the Swedish Orthopedic Institute today.
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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.