Mounting research suggests that, in many cases, discharging patients the same day as their joint replacement surgery is safe and effective. the key, one surgeon says, is selecting suitable patients and preparing them.
Although she was in her forties, Karen Tarbotton struggled with troublesome knees for the last 15 years. So, when she started having trouble lifting her left leg or bending over to tie her sneakers, she initially put off seeing a doctor because she thought the pain was related to her knee and that it was the last straw.
As the summer wore on, her pain became harder to ignore. During a vacation in Ocean City, Maryland, Tarbotton labored so much walking the block-and-a-half to and from the beach she didn’t return that summer.
"And I love the beach," she says.
Helping her daughter move into her college apartment in August was "excruciating"” for her. 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 knees. This time, she saw Christopher Lyons, MD, a surgeon who specializes in hip replacement.
He told her she needed a hip replacement. The news shocked Tarbotton, who thought the pain could be resolved with a shot, the way her knee pain was. He told her that a steroid injection may or may not help, whereas hip replacement surgery would almost certainly relieve her pain and improve her mobility.
As further incentive, Dr. Lyons told Tarbotton that she was also a candidate for a same-day hip replacement, meaning she would be discharged from the hospital the same day she had the surgery.
For Tarbotton, who was trying to come to grips with the idea of having surgery, something she had actively avoided for several months, the possibility that it could be done in a single day was a lot for her to digest.
Knowing What to Expect
The Same Day Discharge program began at Chester County Hospital in 2021 in an effort to allow patients to safely and comfortably recover, but minimize the time they need to stay in the hospital.
Mounting research suggests that, in many cases, discharging patients the same day as their joint replacement surgery is safe and effective. Advancements in technology, surgical, anesthesia, and pain management techniques are aiding the movement.
Beyond the surgeon’s expertise, Dr. Lyons says the most crucial component of the Same-Day Discharge program is preparation.
"To make it happen, you have to prepare the patients well before they arrive at the hospital," he says. "We have a system in place because we do many of these procedures. Basically, we make sure they 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.
Same-day joint replacement surgery isn’t appropriate for everyone.
"We have not had problems with patients who have gone home the same day because they have been patients who have been preselected against a set of criteria that we know increases their chance of successfully going home on the same day," Dr. Lyons says.
Criteria for the program include access to a strong support system after surgery, an ideal home layout where one can avoid stairs temporarily, overall good health, and a maintained body mass index of less than 35.
Following the surgery, and after a spinal anesthetic has worn off, the patient is visited by a physical therapist and an occupational therapist, who will evaluate their ability to safely walk 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 do all of that, they’re cleared to go home, pending a final medical exam.
Home Sweet Home
Rest is integral to healing from surgery. For many, it can be easier to come by in the comfort of their own home. Tarbotton settled 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, 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 says.
It's also essential for patients who undergo joint replacement surgery to get up and move. Dr. Lyons says this process tends to unfold a little more quickly for the patients who are discharged the same day as their surgery.
Before her surgery on January 13, 2022, Tarbotton coordinated with Penn Medicine Home Health to have a physical therapist visit her first full-day home and, for the next three weeks, for a total of six visits. 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 what the physical therapist told her to do “to a 'T'."
About two weeks after her surgery, Tarbotton visited Penn Orthopaedics to have her stitches removed and see Dr. Lyons. He told her she was healing according to plan and encouraged her to continue doing the exercises the physical therapist had shown her.
Even though she was discharged from the hospital less than 12 hours after she arrived there for her surgery, Tarbotton says she never felt as though 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 says. "I was very, very impressed with everyone."
She adds, "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 says she felt "really, really good". That continues to be the case more than a year later. For a time, 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 didn't have the surgery.