Joint Replacement Today, Back Home Tonight

“When I see patients a week or 10 days after their surgeries, they walk into my office without a cane or walker, with smiles on their faces, and sometimes tell me, ‘I didn’t have to take any pain meds!’ They feel great.” Michael Kent, MD

What was once unimaginable is now becoming a reality. Patients undergoing hip and knee replacements at Memorial Hermann Joint Centers are, in many cases, having their surgeries and going home the same day. What has changed to make this possible? The answer may not be what you would expect. Dr. Michael Kent, an orthopedic surgeon affiliated with the Memorial Hermann Joint Center and Regional Medical Director of UT Physicians –Orthopedics, explains. “While most of our patients still go home the morning after their surgeries, after spending one night in the hospital, an increasing number are going home the same day. What’s enabling us to perform these procedures on an outpatient basis isn’t so much advances in surgical techniques – although these procedures have become much less invasive – it’s the great strides we have made in anesthesia and pain management. The better the patient feels, the more likely he or she will participate in physical therapy (PT). The more the patient does in PT, the quicker he or she is safe to go home.”

Advances in Pain Management

“Until recently, most joint replacements were performed under general anesthesia,” Dr. Kent says, “and patients were given narcotic medications for pain management during and after their procedures. These medications carried potential side effects, including nausea and vomiting, constipation and, in some older patients, confusion. Some patients expressed concern about the possibility of becoming addicted to pain medications.” Things have come a long way. “Now, we use long-acting local and regional anesthesia, some of which is injected right into the joint during surgery, to block transmission of pain impulses. This significantly reduces the need for narcotics during and after the procedure. In some cases, patients wake up pain free. Many are up and walking within a couple of hours,” says Dr. Kent.

Faster Recovery

The use of narcotic pain medications also slowed recovery times, sometimes delaying the start of post-operative rehabilitation and physical therapy. Not long ago, a patient undergoing a knee or hip replacement would typically stay in the hospital three days, then would undergo two weeks of inpatient physical therapy plus two weeks of home health care before even starting outpatient therapy. Now, our patients skip inpatient physical therapy and home health care entirely, and start their outpatient rehab within a couple of days following surgery.

Changes in Medicare Coverage

Just a few years ago, same-day joint replacements would have been unthinkable. And until recently, Medicare required patients to spend a night after surgery. But Medicare recently took hip and knee replacements off their “inpatient-only procedures” list, allowing coverage for outpatient joint replacement surgeries.

“Doing the Right Thing for the Patient”

While the capability exists to send some patients home right away, in the final analysis, says Dr. Kent, getting patients in and out quickly is not the most important thing. “Each patient’s situation is unique. If a patient’s procedure is performed early enough in the day, and if there are no factors that suggest the patient should stay, the patient may, in fact, be able to go home and sleep in their own bed. Many of our patients prefer that. But length of stay should not be my focus. What matters most is that we get the patient home comfortably and safely. While it may sound corny, the most important thing is doing the right thing for the patient.” Regardless of whether a patient’s procedure is done same-day or with an overnight stay, joint replacements have come a long way since the days when patients were required to undergo painful procedures and prolonged recoveries. Says Dr. Kent, “When I see patients a week or 10 days after their surgeries, they walk into my office without a cane or walker, with smiles on their faces, and sometimes tell me, ‘I didn’t have to take any pain meds!’ They feel great.”