Nearly 70 years ago, total hip replacement surgery was created and 28 years later, the total knee replacement was introduced. Despite the long history medicine has with these procedures, it is still remarkable that an entire joint in your body can be replaced with synthetic parts and you can be up and walking within hours.
Throughout the decades, advancements in medical procedures, materials and medications have enabled surgeons to shorten surgery and healing times, creating positive outcomes for patients. And, in an effort to continue to improve the patient experience, outpatient total joint replacement surgery is now an option for those who qualify. Does sleeping in your own bed the same day as your surgery sound good to you?
Olympia Orthopaedic Associates has led the way in total joint replacement in the South Sound for decades. The addition of the group’s West Olympia Surgery Center in 2012 has allowed for the expansion of outpatient services, which now include outpatient total joint replacement.
The program rolled out in March 2015, after thoughtful planning and preparation by the surgery center teams. “March 2016 was our one-year anniversary offering this program and we’ve performed over 100 outpatient total joint replacements with great success,” shares Oly Ortho’s Outpatient Surgery Center Medical Director, Stephen Snow.
This major surgery included up to a week-long hospital stay in the past but now can be done, for qualified patients, in one day. “It’s a bit of a paradigm shift,” Dr. Snow admits. “These bigger surgeries can be safely done in an outpatient setting with very high patient safety and patient satisfaction.” Pain control is the key to shortening stay lengths and includes regional nerve blocks, numbing only the surgical region instead of the entire limb. Also aiding this advancement are local, infiltrating anesthetics delivered to the surgical sites.
These advanced pain control methods speed healing, too. “Now people can get physical therapy (PT) right out of the recovery room,” explains Dr. Snow. “They can get right up and start walking instead of waiting a day or more for muscle function to return.” The sooner patients can demonstrate mobility, the sooner they can go home safely.
“We’ve found that if people expect to stay for three days in the hospital, they stay for three days. If they expect to go home that day, they are disappointed if they can’t,” says Dr. Snow. “By preparing them and their expectations in advance, patients are much more likely to successfully follow their post-surgical plans.”
Paramount in helping patients prepare for outpatient total joint surgery are Surgery Center Director Sylvia Johns and Nurse Navigator Becki Taylor. The initial step is to assess if a patient is a good candidate for the procedure.
“We have selection criteria that we use to see if the patient is right for our program,” shares Taylor. “First, the patient has to be motivated and have good family support at home. Second, they have to be healthy — meaning they can’t be significantly overweight, have any underlying heart conditions or other critical medical issues.” Often, patients just aren’t a good fit for the outpatient options and Oly Ortho works in concert with their hospital partners at Capital Medical Center and Providence St. Peter Hospital to create an in-patient surgical plan.
After being accepted into the program, the patient and their caregiver(s) attend an outpatient joint replacement class. Here, they receive a preview along with instructions for surgery day as well as home recovery. Patients also attend a pre-operative physical therapy session where the home environment is assessed, ensuring everything is in place for the patient to be successful at home. “We give them all this information proactively so that they can be successful and are able to go home that same day,” Taylor says.
Things previously arranged post-operatively, at the hospital, now can be done in advance. Arranging a walker, scheduling and seeing physical therapists, and securing prescriptions are now pre-arranged and planned, which enables patients and their caregivers to manage recovery on their own. “Everything is set up in advance so the transition from here to home is seamless,” explains Taylor.
Taylor herself is one of the most valuable assets to the program. “Becki’s role is key to our success,” says Johns. “What she does is a bit like a concierge service that she provides to the patients so they know they can reach someone directly with any questions. Becki really prepares them from beginning to end, which has influenced patients to be very motivated.” She’s available by phone and email and follows up with each patient the day after — and a week after — surgery.
Dr. Snow and the entire Oly Ortho team are proud of the program’s success and look forward to increasing the number of patients served. However, Dr. Snow also notes that a full 80% of total joint replacements are still performed as inpatient procedures at both local hospitals and are a safe and appropriate option for many patients.
“We are really here to serve our community — that’s what we’re all about,” says Dr. Snow. “With all the options we have locally, you really don’t need to leave Olympia for a joint replacement surgery.” Olympia Orthopaedic Associates is on the leading edge of a national trend to offer more outpatient procedures in stand-alone surgery centers and encourages those facing a total joint replacement to see if the innovative procedure is right for them.
Learn more about Olympia Orthopaedic Associates online or call 360-709-6230.