On December 11, 2014, a surgical team at CHI Health St. Elizabeth led by James W. Gallentine, M.D. was the first in Nebraska to perform a same day, outpatient, total hip replacement without an overnight stay. The patient spent approximately 12 hours in the hospital from arrival to discharge.There has been a concerted effort in the field of total joint arthroplasty to continue to improve patient outcomes and satisfaction while controlling cost. Advances in pre-operative patient education, patient expectations, hemostasis, pain management, DVT prophylaxis, and surgical approaches have continued to improve the patient’s experience during hip and knee replacement. While outpatient hip and knee replacements have been performed to an extent on the coasts, this is the initial effort on this front in the Lincoln medical community.During this procedure, the patient underwent a total hip arthroplasty under a spinal anesthetic through a direct anterior approach, had a long acting local anesthetic injection at the time of surgery, and nearly immediate physical and occupational therapy after the procedure. The combination of these procedures coupled with the patient’s motivation allowed for a same-day dismissal for what has otherwise traditionally required 3 nights in the hospital.
James W. Gallentine, M.D. of Nebraska Orthopaedic and Sports Medicine, P.C. indicated that for this type of procedure to be successful, it requires a total team approach and buy-in regarding what is possible. Patients must to put forth the effort to optimize their medical condition, while they and their family or friends need to become educated on the plan and requirements post-discharge. The operating room team needs to run efficiently to complete the procedure without complications in a timely and predictable manner. The nursing staff and therapists post-operatively play a tremendous role in assisting the patient in ambulation, medication requirements, and continued teaching. “If done well, the patient can avoid having to spend the night in the hospital while the family doesn’t have to navigate the issues that arise with hospitalization and multiple-day stays of their family member,” says James Gallentine, M.D.
The direct anterior approach to total hip replacement has been performed in the Lincoln market for around the last 4 years and currently accounts for about 25% of the total joints performed in the United States. While all approaches to hip replacement yield excellent results, the direct anterior approach is felt to be advantageous in the immediate post-operative period as it leads to a very stable articulation with a low rate of hip instability and dislocations, requires minimal hip precautions, and has limited initial loss of strength.
As health care reform continues, moving patients towards shorter hospital stays without adversely altering outcomes is a top priority. By using such a multi-modal approach, it is felt that patients can be provided with a valuable procedure that improves their quality of life, diminishes pain, improves independence, and limits the time needed as an in-patient while hopefully limiting cost and complications.