Hip replacement surgery has been one of the most successful procedures in medicine to improve the quality of life, restoring patient’s function to an active and productive lifestyle. Recent advances have emerged to allow for hip replacements to be performed one day and selected patients can go home the next day. This has been possible due to advances in technology, surgical technique, and protocols.
The development of muscle sparing surgical techniques has greatly influenced the speed of initial recovery following surgery. One type, the direct anterior approach, is a small incision (also called minimally invasive), but has relative little trauma to the muscle about the hip joint. New instruments have allowed us to insert the best time tested implants. This approach is appropriate for many but not all patients undergoing hip replacement surgery. Patients are mobilized with the assistance of experienced physical therapist on their hips full weight on the day of surgery, without any motion restrictions. Also on the day of surgery, some patients are doing stairs and getting in and out of a practice car.
Another important element in this program has been the development of improved management of postoperative pain. This starts prior to surgery by giving patients several different types of pain medications to block nerve signals to the brain before the operation (pre-emptive analgesia). Intraoperative injections into the soft tissues around the operative site are helpful for pain reduction for the first 12-18 hours after surgery. Lastly, using a combination of Tylenol, nsaids, and non-narcotic analgesics manage the pain and minimize side-effects of narcotics.
New protocols at Crouse Hospital influence patient care and culture resulting in safe and rapid discharge the next day. All patients are strongly encouraged to attend a specially created teaching class which is extremely informative and allows for lengthy questions. It helps set appropriate expectations for what will happen to the patients and alleviate anxieties. Cultural changes include the simple act of discarding hospital robes and wear comfortable clothing soon after the patient arrives on the orthopedic floor. At SOS, we have assisted the hospital discharge planners with a nurse navigator, who guide the patient thought the process; including home therapy, nursing and then outpatient rehabilitation. We anticipate that in a few years, selected patients will have hip replacement surgery as a one day outpatient procedure.