How Are So Many Total Joint Replacements Performed in an Outpatient Setting?

by Dr. Benjamin Schwartz and Dr. William Rubenstein

Joint replacement surgery is one of the most common procedures in the U.S. and previously required an overnight hospital stay. Increasingly, these surgeries are often performed in outpatient settings for appropriate candidates, offering patients convenience and safety by allowing them to return home the same day. This shift to outpatient joint replacements has been made possible by advancements in medicine, including the soft tissue-sparing approach and advanced technology, as well as enhanced pain management strategies that often eliminate the need for opioids.

Improved Surgical Techniques

Significant advancements in pain management techniques and protocols have made outpatient joint replacement both possible and safe, while also reducing the need for opioids.

There have been several advancements in surgical techniques that make outpatient joint replacement possible and safe, such as:

• Minimally invasive procedures: Smaller, specialized instruments are used to make smaller incisions, allowing for more healthy tissue to be preserved.
• Soft tissue sparing approach: This minimally invasive approach is increasingly popular for outpatient hip replacement surgery. With this approach, there is less trauma to the muscles and tendons around the hip. It has been gaining popularity due to a minimally invasive approach, fewer activity restrictions and precautions, and a potentially faster recovery.
• Advanced technology: New technologies such as robotics, digital surgical planning tools, and modern hip and knee replacement designs assist surgeons in personalizing your surgery and improving the function and longevity of your replacement.

These surgical techniques, combined with advanced pain management strategies, lead to improved patient satisfaction and outcomes.

Improved Multimodal Pain Management Protocol

Innovative pain management strategies have played a vital role in enabling outpatient joint replacement while reducing opioid use.

Multimodal pain management involves using two or more medications to deliver pain relief through various pathways. Examples include:

• Pre-operative medication: Patients can manage pain proactively by taking non-opioid medications such as NSAIDs.
• Regional anesthesia: Nerve blocks and epidurals provide targeted pain relief to specific areas, easing postoperative pain.
• Local analgesia: This technique involves the direct injection of anesthetics into the surgical site toward the end of surgery.

Improved Surgical Preparation

In recent years, improvements in patient preparation have significantly contributed to the success and safety of outpatient joint replacements. By optimizing patients’ health, utilizing a multi-disciplinary approach, and implementing thorough screening processes, the chances of a smooth and successful recovery are greatly increased.

• Significant advancements in pre-surgical preparation have made outpatient joint replacement safer and more effective. By optimizing patients’ health, utilizing a multi-disciplinary approach, and implementing thorough screening processes, the chances of a smooth and successful recovery are greatly increased.
• Health optimization: Working with your medical team to make sure you are as healthy as possible prior to surgery increases your chances of a smooth and safe recovery.
• Multi-disciplinary approach: Collaboration between your surgeon, the anesthesia team, nurse coordinators, and physical therapists provides a coordinated experience throughout your journey.
• Screening process: A thorough review of your medical records and support system allows for a comprehensive understanding of the factors necessary to ensure a successful outcome.
  
  

All of the above techniques are examples of opioid-sparing strategies, which means they help minimize or eliminate the need for opioid medications, reducing the risks associated with opioid use, such as addiction and adverse side effects.

Is outpatient joint replacement surgery right for you?
These advancements in surgical techniques, pain management protocols, and surgical preparations allow patients to recover in the comfort of their own homes, making outpatient joint replacement a safe and convenient option for many. Learn more about outpatient joint replacement surgery at SMN and see if you are potentially a good candidate here.

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About Dr. Benjamin J. Schwartz
Benjamin J. Schwartz, MD, is a fellowship-trained, board-certified orthopedic surgeon at Sports Medicine North specializing in the surgical and nonsurgical treatment of arthritis of the hip and knee, including total joint replacement and revision. He is the Total Joint Director for the Orthopedic Surgical Center of the North Shore (OSCNS).

About Dr. William Rubenstein
Will Rubenstein, MD, is a fellowship-trained orthopedic surgeon specializing in hip and knee replacement surgery. Dr. Rubenstein focuses on both surgical and non-surgical treatments of hip and knee arthritis. He performs the entire spectrum of joint replacement surgeries including partial and total knee replacements, hip replacements, and revision hip and knee surgery.