Dr. Matthew Levy, orthopedic surgeon, writes a monthly column for the Cleveland Jewish News focusing on orthopedic issues, concerns and topics. This column was originally published in Cleveland Jewish News on March 11, 2021.
Gone are the days when hip replacement surgery required a multiple day hospital stay. Advancements in implant technology, surgical technique and pain management have ushered in a new era that allows many patients same-day surgery and the benefits it provides.
Before the COVID-19 pandemic, experts estimated more than 1.2 million total joint replacements in 2020 in the United States. At the time, it was believed 10% would be done as an outpatient procedure. However, the pandemic has advanced demand and offering of outpatient procedures, which are expected to grow to more than 50% in five years.
It is important to note I do not recommend outpatient hip replacements for everyone. Not everyone is an ideal candidate, but many are, including those who are:
• Motivated: Those with a positive attitude, have lost any necessary weight before surgery, and demonstrate a willingness to follow doctor’s orders and their physical therapy recovery plan.
• Healthy: Patients who are generally healthy, without significant medical co-morbidities and are active and independent.
• Prepared: Pre-surgical preparation is essential. Things typically taught in the hospital – walking on crutches and walker, preparing your home to accommodate recovery, an exercise rehabilitation plan – all need to be done in advance.
• Supported: Coming in for surgery in the morning and leaving for home the same day requires patients to have a wider support network for assistance at home and for subsequent physical therapy.
Experience and research combined demonstrate multiple benefits for patients with outpatient hip replacement. Outpatient surgeries often utilize a less-invasive surgical approach, with a smaller incision that results in less pain than traditional surgery. In addition, those receiving outpatient surgery receive a long-lasting local anesthetic that enables pain control for up to two days afterward. Anecdotally, we also know that patients tend to feel more comfortable, more relaxed and sleep better, which impacts one’s measure of pain.
Less time in the hospital also means a lower risk of infection or exposure to disease, such as COVID-19. As meticulous as any hospital is in cleaning and disinfecting, there is always a greater risk of exposure simply because of the sheer number of people in the hospital with a wide range of illness.
All of this adds up to faster recovery times for most patients. Less disruption to surrounding muscle and tissue and less blood loss through minimally invasive surgery, along with fewer infections and longer-lasting anesthetic, all add up to a patient’s ability to progress faster with rehabilitation and more quickly return to normal activity under their doctor’s supervision.
And, finally, there is always the bottom line – cost. Outpatient surgery can save patients, on average, 30% to 40%. To put that in perspective, consider the typical in-patient hip replacement runs more than $30,000, which, as outpatient, translates to significantly less copay and expense.
Total hip replacement surgery is a highly successful surgery, whether as in-patient or outpatient. However, if you believe you are a good candidate for outpatient surgery, be sure to discuss as an option with your surgeon.
Born and raised on Cleveland’s east side, Dr. Levy worked for 14 years as team physician for local sports teams. After graduating from Case Western Reserve University Medical School in Cleveland, he completed his internship and residency at Mount Sinai Medical Center in Cleveland. Levy is also fellowship trained in sports medicine. He sees patients in Solon, Independence and downtown Cleveland.