Same Day Joint Replacement a Hit

Imagine “going to sleep with chronic joint pain, waking up with no pain and walking out of the hospital on the same day, ” wrote Anaka Ucheghu for the Pittsburg Post Gazette. She was writing about a program at West Penn Hospital of the Allegheny Health Network

Ucheghu quoted Nick Sotereanos, M.D., the orthopedic surgeon who performed Allegheny Health Network’s first same-day hip replacement as saying, “This is phenomenal, and it’s because of the baby boomers. There is a huge economic push to make this procedure less expensive and quicker.”

A year and a half ago, for carefully selected patients, Allegheny Health Network began offering same-day total hip replacements. In May, surgeons performed the first same-day total knee replacement at Allegheny General Hospital.

Michael Seel, M.D., director of orthopedic surgery at West Penn Hospital said that good candidates for same-day joint replacements are in their 60s or younger and do not have any other medical problems, such as heart disease. Patients are discharged only if they can walk with assistance between 40 and 75 feet, can get out of bed, use the bathroom, and go up and down a flight of stairs unassisted.

Ucheghu reported that John Meeker, 51, was the first to experience Allegheny Health Network’s same-day total knee replacement operation. Meeker said that his recovery has been smooth. “Three hours after the surgery I was walking down the hall with a walker, and they let me go the same day.” He added that he had not felt groggy or in pain when he woke up.

Seel said the surgical technique is the same for same-day patients and overnight patients. But improved surgical and pain management techniques have enabled some patients to avoid a night in the hospital.

Doctors quoted by Ucheghu said that managing pain and the side effects of narcotic painkillers is one of the main factors behind the need for overnight hospitalization.

Surgeons at Allegheny Health Network say that they have made hip replacements less painful by approaching the hip from the front and not cutting into the thick muscle behind, and at the side of the hips.

For knees, an anesthetic delivery system allows patients to receive post-operative pain drugs at home. A pump delivers anesthetics to the branch of the nerve going to the knee that controls pain and not the branch that controls movement. Patients can go home with this pump. Doctors say at least 400 knee replacements have been done at Allegheny General Hospital using this pain pump in the past year.