Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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S E P T E M B E R 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 7 Dedicated doctors Your facility must be staffed with high-volume orthopedic surgeons who have a long track record of doing these procedures efficiently and safely. My partner and I each perform 800 to 1,000 hip- and knee-replacements and revisions each year. Collectively, that's the largest annual volume of primary and revision joint replacement sur- geries in the state of Delaware. One major reason we're able to perform such a high-volume of cases is specialization: I don't per- form upper-extremity procedures and our joint replacement team is made up of sub-specialized, fel- lowship-trained surgeons. Same-day total hips take a lot of extra work and commitment from the surgeon's perspective. The pre-operative process and post-operative follow-up protocols are much more involved, but the extra steps are necessary to make sure patients aren't admitted to the hospital or suffer avoidable complications. You should also consider working with a rep- utable consulting partner who can help you set up the comprehensive clinical pathway needed to perform these procedures successfully on an out- patient basis, including standardized preoperative protocols and a robust postoperative follow-up process. The average time it takes to complete a hip replacement depends on the surgeon. It typically takes our surgeons about 35 minutes. But admitted- ly, that's fast. In general, a hip replacement will take about an hour for most surgeons to complete. In terms of surgical technique, surgeons can access the hip in various ways: • Anterior approach. This isn't a new technique, but it has undergone a recent resurgence due to marketing. The minimally invasive approach uses a small incision on the front of the hip, allowing the surgeon to replace the joint by moving muscles along their natural tissue planes without detaching any tendons. While the approach has been around for decades, it recently has been publicized in a manner that it is "new and different." • Posterior approach. With this approach, the patient is positioned on their side. The surgeon then makes an incision — which goes through muscle and detaches some muscles from the "ball and socket" of the hip joint — along the buttock area, just beside or behind the hip joint. • Anterolateral approach. This is my preferred technique. It lets me operate through a single small incision and work between muscle groups, which minimizes trauma to soft tissue in the joint. This approach is one of the reasons patients can ambu- late soon after surgery and prepare for discharge in just a few hours. There are no long-term benefits associated with one approach over another. Surgeons should ulti- mately use the one they feel most comfortable with in order to achieve excellent results. Pain management advances In the outpatient setting, we typically perform four cases a day. If a patient has surgery at 9 a.m., they're usually ready to go home by 1 p.m. That's due in large part to advancements in post-op pain control. It's now standard practice to include a mul- UNDER THE KNIFE Emerging technologies and techniques allow most surgeons to replace a hip in about an hour.