Total hip and knee replacement surgery can be a quick turnaround for many patients these days. According to Rothman Orthopaedic Institute doctors Gregg Klein, Ari Seidenstein and Harlan Levine, it is indeed possible for some patients to safely undergo outpatient and same-day discharge for these procedures.
Klein said this procedure represents a clear advantage for those having surgery amid the COVID-19 pandemic. The outbreak has led to an increase in both patients’ and surgeons’ enthusiasm about shorter hospital exposure and faster recovery. Patients who have outpatient surgery are generally healthy and do not want an inpatient stay.
“I think COVID-19 changed everything. No one wanted to be in a hospital. No one wanted to be in a health care facility, Klein said. “We learned that it can be done. It really is, one, surgery and surgery techniques; two, the protocols, the pain medications and the anesthesia; and three, patient motivation. People that wanted to go home, do well going home. People that come into it saying ‘I can’t do it,’ can’t pull off of doing it.”
Klein added that he thinks patients who opt for the same-day discharge do better. “I think they recover quicker. I think they have less chance of being exposed to other things in the hospital. I think it’s a great option for the vehicle.”
These patients can go home the same day as their surgical procedure. However, not all patients are candidates for outpatient surgery. Patients must be healthy, fit, and motivated. They must have a support system in place for their recovery, including the help of family or friends.
According to Seidenstein there are things that patients can do ahead of time to improve their recovery time. “Losing weight is always a good idea. There have been studies on pre-operative physical therapy, which haven’t really shown to do much, but that doesn’t mean that you shouldn’t try and get to the best shape possible because that’s what you really depend on afterwards,” Seidenstein said.
He also advised to quit smoking and advised people with diabetes to get their A1C numbers under control. “If you are a smoker we recommend that you stop smoking three months prior to the operation, from both a physical and medical standpoint. If you’re a diabetic as well, your diabetes needs to be under control because all those things are modifiable and if you can get yourself as optimized as possible, you can help ensure that you have a good outcome.” Patients interested in same day surgery should discuss the pros and cons with their doctor to find out if they are in fact a candidate.
The advantages of outpatient surgery are clear, according to Levine. “The primary focus is really on the patient and the patient experience. You know, the goal of any surgery is to try to restore function and reduce pain in as efficient a manner as possible for the patients to make this as easy as we can for them.”
Avoidance of a hospital stay also limits potential exposure to COVID-19 infection. In addition, patients may be happier at home. They can sleep in their own bed, interact with family members and eat meals of their choice. A good night’s sleep can aid in recovery and potentially lead to a better state of mind. Patients can also be more independent at home. They don’t need to rely on nurses and hospital staff. They can recover on their own schedule. Get up when they want, walk when they want, and eat when they want.
“In our initial experience we saw that the faster we could get patients up and get them to move, the faster, at least their initial recovery was,” Levine explained. “They didn’t start to play the part of a patient who was sitting in bed, waiting for things to happen to them. They actively participated in the early active recovery.”
Some patients are apprehensive about outpatient surgery as they are worried or anxious about receiving reduced medical supervision. But recent studies show that healthy patients are not at increased risk and that there is no heightened risk for complications, readmission or emergency room visits. In addition, some patients are concerned about having pain or nausea after surgery. Patients who go home the same day will be discharged on the same medications they would get in the hospital.
In fact, the patients can manage their own medications and take them when necessary. They don’t need to rely on nurses or staff to administer the medication.
Other patients are concerned about less exposure to physical therapy. Yet recent evidence shows that not having formal physical is not inferior to formalized therapy programs.
But Levine said there are four facets to a physical therapy program or an exercise program that make it successful.
First and foremost is the importance of strength training. “Everybody recognizes the importance of strength training. They go to the gym, push some weights around and try and build muscle. But strength training increases bone density and reduces the risk of fractures. It also helps joints stay flexible and can reduce the symptoms of arthritis.”
In fact, flexibility is crucial. “The second is things is to promote flexibility and range of motion as soon as you notice you’re a little stiffer than you used to be. So working on range of motion exercises is very important because patients tend to get stuck and tend to not want to move and then everything starts to get stiff and that’s the worst thing you can do with arthritic joint.”
The third facet according to Levine is to work on things that help with balance, gait and agility. Balance training involves doing exercises that strengthen the muscles that help keep you upright, including your legs and core. These kinds of exercises can improve stability and help prevent falls. He recommends exercises including yoga and Tai Chi as they lend themselves well to that.
The final facet is anything that promotes cardiovascular endurance. The other three facets all work better if the heart is healthy.
“In order to do pretty much any one of those four things, you need the three others, you know, and as far as I’m concerned you can’t do cardio unless you have balance because you take your eyes off of your path or where you’re heading,” Levine said. “So you need your balance each year range of solution for your pickup stride and, you know, still tuning and all that regardless of how you do it yoga”.
But certain exercises more vigorous, and more load-bearing than others, it’s important to find the one that works for you.
“Running is example of one exercise that may not be for everyone. I think it’s hard for people – the impact and jostling – a everybody can do it. So learning to exercise within whatever boundary or your body puts on you is important.”
Levine suggests an elliptical machine, rowing, biking, or swimming. And he said that vigorous walking has tremendous benefits.