Outpatient Total Hip And Total Knee Replacement: A Trending Paradigm Shift

Jan 5, 2021

Even a few years ago, a 3 night stay in the hospital was standard of care for anyone undergoing total joint replacement. The principal reason for the hospital stay was pain management with intravenous narcotics and supervised inpatient physical therapy. Gradually, with better preparation for surgery and better surgical and pain management techniques, the hospital stay shorted to 2 days and then 1 overnight for healthier patients with support at home. 

Today, across the country, roughly 35% of patients are discharged within one day of joint replacement and a smaller percentage of patients may go home the same day. Outpatient joint replacement has many advantages and as surgeons and programs gain experience with same-day discharge, the criteria for who is eligible for this option have expanded to older patients and those with well-managed medical conditions. The major impediment to outpatient joint replacement is fear of hospital readmission. In addition, some hospitals have been slow to adopt the changes necessary to allow same-day discharge due to the potential for lost revenue from an inpatient hospital stay. 

Our practice began outpatient (same-day) hip, knee and shoulder replacement over 5 years ago. Over this time period we have developed our AVATAR program (Alignment of Vital Assets to Accelerate Recovery) which now allows a majority of our patients to recover in the comfort of their own home just hours after surgery. AVATAR focuses on all aspects of the joint replacement process from preoperative education and preparation, to patient optimization, best surgical techniques, multimodal pain management and personalized stewardship of the postoperative process. 

For patients with commercial insurance plans and for Medicare patients who require a total knee replacement, AVATAR joint replacement can be performed in an outpatient surgery center, avoiding the hospital all together. As the number of COVID hospitalizations continues to rise during the winter months, outpatient surgery may prove to be safer for patients and caregivers undergoing these elective procedures.

Our outpatient joint replacement program boasts a complication rate well below the national average for infections, other surgical complications and hospital readmissions. Our navigation team has allowed for us to care for many patients traveling from a distance to our center including all of New England and Canada. We are capable of managing medical tourism for knee replacement, hip replacement and shoulder replacement including physical therapy services in local hotels.

If you are considering joint replacement surgery, there are advantages to outpatient surgery. For our practice, this is a commonplace practice and our AVATAR experience makes the difference in outcomes.