Same-day discharge can speed up joint replacement healing

Mounting research suggests that in many cases, discharging patients the same day as their joint replacement surgery is both safe and effective. The key, according to Penn Medicine orthopedic surgeon Christopher Lyons, MD, is selecting suitable patients and fully preparing them for what lies ahead.

One patient's struggle

Although only in her forties, Karen Tarbotton had struggled with troublesome knees for 15 years. When she started having difficulty lifting her left leg and bending over to tie her sneakers, she initially put off seeing a doctor thinking it was just her worsening knees.

However, as time went on, her pain became harder to ignore. During a vacation in Ocean City, Maryland, Tarbotton had so much trouble walking the block-and-a-half to and from the beach that she didn’t return again that summer.

“And I love the beach!” she said.

By the time fall rolled around and she was helping her daughter move into her college apartment, Tarbotton described her pain as “excruciating.”

Soon after, Tarbotton saw her primary care doctor, who suspected her left hip was causing the distress, and ordered an X-ray. Tarbotton then scheduled an appointment at Penn Orthopaedics, where John Manta, MD, had been treating her knee issues. This time, she saw Lyons, an orthopedic surgeon specializing in hip replacement.

Hip replacement surgery treatment options

Following an assessment, Lyons told her she needed a hip replacement. The news shocked Tarbotton who hoped that like her previous knee pain, this pain could be resolved with a shot. Lyons explained that a steroid injection may or may not help, while hip replacement surgery would almost certainly relieve her pain and improve her mobility.

As further incentive, Lyons said she was a candidate for a same-day hip replacement and could be discharged from the hospital on the day of her surgery.

For Tarbotton, who was trying to come to grips with the idea of having surgery—something she had actively avoided for months--the possibility that it could be done in a single day was encouraging.

Same-day discharge for joint replacement surgery

The Same-Day Discharge Program at Penn Medicine allows patients to safely and comfortably recover at home, minimizing time in the hospital. Advancements in technology and surgery, anesthesia, and pain management techniques are helping to make this possible.

Beyond the surgeon’s expertise, Lyons says the most crucial component of the same-day discharge program is preparation.

“To make it happen, you have to prepare patients well before they arrive at the hospital,” he said. “We have a system in place because we do many of these procedures. Basically, we make sure patients clearly understand what will happen and our expectations for them.”

In addition to reviewing the procedure with the surgeon and their staff, patients receive an information booklet explaining the process in detail, including what to expect and how to prepare for recovery.

Although same-day joint replacement surgery isn’t appropriate for everyone, “we have not had problems because our patients have been preselected against a set of criteria that we know increases their chance of successfully going home on the same day,” Lyons said.

Criteria for the program include:

• Access to a strong support system after surgery
• An ideal home layout where stairs can be temporarily avoided
• Overall good health
• A maintained body mass index of less than 35

Following the surgery and after a spinal anesthetic has worn off, a physical therapist and an occupational therapist visit the patient. They evaluate their ability to safely move around with the assistance of a walker, negotiate a set of training stairs, and climb into and out of a simulation car.

If the patient can successfully perform these activities, they’re cleared to go home, pending a final medical exam.

Healing at home

Rest is integral to healing from surgery. For many people, this is easier in the comfort of their own home. For Tarbotton, that meant settling into a recliner in her living room the first night after her surgery (“just because that was the easiest place for me to get up and down”) and much to her surprise, she slept for six or seven hours straight.

“I know if I would have been in the hospital, that would not have been the case,” she said.

It's also essential for patients who undergo joint replacement surgery to get up and move. Lyons explained this process tends to unfold a little more quickly for patients who are discharged the same day as their surgery.

Before her hip replacement surgery, Tarbotton coordinated with Penn Medicine Home Health to have a physical therapist visit her during her first full-day home and for the next three weeks—a total of six visits. In addition to managing her rehabilitation, the therapist also checked her vitals and stitches. Having never had a major surgery or used a walker, Tarbotton says there was a learning curve, but she managed by following the physical therapist's instructions “to a ‘T’.”

About two weeks after her surgery, Tarbotton visited Penn Orthopaedics to have her stitches removed and follow up with Lyons. He told her she was healing according to plan and encouraged her to continue doing the exercises the physical therapist had shown her.

Support after surgery

Even though she was discharged from the hospital less than 12 hours after she arrived for her surgery, Tarbotton never felt like she was on her own.

“Dr. Lyons and his staff were very responsive in addressing my questions. And my physical therapist knew just when to push me and when it was enough,” she said. “I was very impressed with everyone. I don’t have a single complaint about the entire process, from scheduling the surgery and the pre-op testing to the physical therapy at home and follow-up exams.“

Two months after her surgery, Tarbotton said she felt “really, really good,” and that continued. In the past, she couldn't imagine what her life would be like if she needed joint surgery. Today, she can't imagine what it would be like if she hadn't had the surgery.

For people dealing with chronic joint pain, hip or knee replacement surgery could help. Learn about joint replacement at Penn Medicine, including same-day discharge for surgery patients in good health and with a recovery support system at home.