QUICK TURNAROUND: John Meeker, 51, of Nottingham, Pa., has his knee worked on by physical therapist Mike Degregorio at Allegheny Health Network Outpatient Care Center in McMurray, Pa. Meeker had a total knee replacement and was discharged the same day as his surgery.


By Amaka Uchegbu


Imagine going to sleep with chronic joint pain, waking up without pain and walking out of the hospital the same day.
For Daniel Currie, 57, of Franklin Park, Pennsylvania, this was no dream.
After suffering with osteoarthritis for more than a decade, Currie had a three-hour hip replacement surgery and was discharged from West Penn Hospital hours later.
He is one of a growing number of people having same-day joint replacements.
“When I woke up, it was wonderful,” Currie said. “Typically I feel pain all the time, so waking up without pain from a night where (I could) barely sleep was wonderful.”
Joint replacements are a way to treat advanced arthritis that has not responded to nonsurgical treatments such as anti-inflammatory medication and activity changes, said Michael Seel, director of orthopaedic surgery at West Penn Hospital.
Both knee and hip replacements typically require an average hospital stay of two to three days.
A year and a half ago Allegheny Health Network began offering same-day total hip replacements. In May, the first same-day total knee replacement was performed at Allegheny General Hospital.
“This is phenomenal, and it’s because of the baby boomers,” said Nick Sotereanos, the orthopaedic surgeon who performed Allegheny Health Network’s first same-day hip replacement.
“There is a huge economic push to make this procedure less expensive and quicker.”
Still, not all hospital systems are making this jump.
Chuck Finder, University of Pittsburgh Medical Center’s media relations manager, said the shortest hospital stay allowed for total knee and hip replacements at UPMC hospitals is 23 hours because literature proving the safety of shorter stays is scarce.
One UPMC surgeon, who declined an interview, shared a 2014 article in the The Journal of Arthroplasty that showed an increased, but not statistically significant, adjusted risk of wound complications in same-day knee replacements. Among some of the complications from this procedure are infection, development of blood clots and nerve injury.
John Meeker, 51 — the first same-day total knee replacement patient in the Allegheny Health Network — said his recovery has been smooth. He has been surprised by how quickly he is recovering.
“Three hours after the surgery I was walking down the hall with a walker, and they let me go the same day,” said Meeker, adding that he was not groggy or in pain when he woke up.
Dr 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.
The first knee replacement was performed in 1968, according to the American Academy of Orthopaedic Surgeons. Now more than 600,000 knee replacements are performed each year in the United States, according to the Agency for Healthcare Research and Quality.
More than 90 percent of patients who have total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living, according to the AAOS website.
The first outpatient knee-replacement in Pittsburgh was conducted at St Clair Hospital in October 2014, said Brett Perricelli, chief of orthopaedic surgery at St Clair Hospital.
Dr Perricelli performed the procedure on a 64-year-old male. One other outpatient knee replacement has been performed since then at St Clair.
“The procedure is not for every patient,” Dr Perricelli said. “The patient’s pre-functional status, social support and medical needs must be carefully evaluated.”
Several studies show that same-day joint replacements can yield successful results if they are done on the right patient using a well-executed technique.
Richard Berger, an orthopaedic surgeon at Rush Medical Center in Chicago who did his residency at Pitt, is a pioneer of a minimally invasive hip and knee replacement technique. He led a 2009 study, published in the journal Clinical Orthopaedics and Related Research, that found that same-day knee replacements require “perfect execution” to be successful.
A study presented at the 2014 annual AAOS meeting showed a small increase in readmission rates among outpatient joint replacement patients compared to inpatients.
But the study said patient selection is key.
“In properly selected patients, the outcomes of outpatient (total joint replacements) are comparable to inpatient (joint replacements) without increasing readmission rates,” the study read.
Good candidates for same-day joint replacements are in their 60s or younger and lack other health problems, such as heart disease, West Penn’s Dr Seel said. Patients are discharged only if they can walk with assistance between 40 and 75 feet — about the length of a city bus or longer — and get out of bed, use the bathroom and go up and down a flight of stairs unassisted.
Dr Sotereanos said managing pain and the side effects of narcotic painkillers is the main factor behind the need for overnight hospitalisation.
Surgeons at Allegheny Health Network 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, he said.
For knees, a different anaesthetic delivery system has allowed patients to receive post-operative pain drugs at home.
A pump delivers anaesthetics 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 because of improvements made to the device over the years. At least 400 knee replacements have been done at Allegheny General Hospital using this pain pump in the past year, Dr Sotereanos said.
The material used for joint replacements — metal alloys, ceramic or strong plastic — is the same for overnight and same-day patients, Dr Sotereanos said.
“It doesn’t cost any more, the quality is identical, and we wouldn’t have it any other way,” Dr Seel said, adding that implants can last up to 20 years.
Patients recover better at home because they are not at risk of hospital-borne infections, and have the opportunity to resume their normal routines and be independent, said Timothy Sauber, the Allegheny Health Network orthopaedic surgeon who performed Meeker’s knee replacement.
Meeker said he was walking unassisted 25 days after his surgery.
“I understand that rehab takes some time, but I’m standing straight up here talking to you,” he said.
“I feel no arthritic pain whatsoever.” —Pittsburgh Post-Gazette/TNS