Until recently, people who needed a hip replacement were operated on in a hospital, spent a few nights there and then went home or to a rehabilitation center to embark on a recovery period of up to three months or more.
Now: An increasing number of people are receiving so-called “same-day” hip surgery—you arrive at a hospital or outpatient center in the morning, have the surgery (typically lasting about an hour or so), spend a few hours recovering from anesthesia and then go home at the end of the day.* Even though this approach may sound appealing, it is not necessarily for everyone.
To learn more about same-day hip surgery, Bottom Line Health spoke with Matthew S. Austin, MD, a leading orthopedic surgeon who performs both traditional and same-day hip replacements and researches optimal recovery methods.
First things first—who needs a hip replacement? It’s mainly done in patients with arthritis or injury-related hip damage that causes persistent pain. Surgery is recommended when people can no longer do the activities they enjoy and/or when they’re suffering from chronic pain that isn’t relieved by medications or the risks of taking painkillers outweigh the benefits.
How is a hip replacement done? In a nutshell, the arthritic joint is cut and removed and then replaced with a synthetic “ball-and-socket” that works much like a natural joint…and much better than an arthritic/damaged joint.
Most hip replacements (including same-day surgeries) are done posteriorly. The surgeon enters the back of the hip to access the hip joint. The incision is typically about six to 10 inches long, although the same procedure can now be done with smaller incisions.
The operation can also be done anteriorly, with an incision on the front part of the hip…or anterolaterally (on the side). With these two techniques (both of which usually require an incision of about four inches or less), the surgeon moves muscles instead of cutting and reattaching them. A surgeon who’s experienced in any of these three surgeries can complete the operation in about an hour.
Is there a preferred technique for same-day surgery? It makes no difference. The different surgeries have similar success rates—roughly 20 years after surgery, about 85% will still have their implant. Same-day surgery is a different process, not a different surgery.
What do you mean by “process”? It has to do with the care that’s given during the time before and after surgery. The same-day approach involves more of a team effort than conventional surgery…and the process begins well before the actual operation.
Patients have to be medically optimized to reduce the risk for complications and allow them to recover at home instead of in the hospital. A diabetic patient, for example, will be encouraged to stabilize his/her blood sugar before having the surgery. Someone who’s obese might be advised to lose weight. Even though these recommendations also apply to people having a conventional hip surgery, they are crucial if a patient wants to go home the same day as the surgery.
The same-day approach also requires an extensive support system. Patients having same-day surgery might meet with team members, such as nurses and physical therapists, to learn such things as how to get around on crutches (usually needed for a couple of weeks)…how to safely climb stairs…how to bathe and use the toilet…and how to manage postsurgical nausea. A discharge planner will ensure that they have adequate support at home—for example, a spouse or a friend who can help them with meals, etc.
In addition, you’re encouraged to stay in close contact with doctors, nurses and other support staff. A nurse or doctor should be available 24/7 to answer questions.
Isn’t this riskier than staying in the hospital? Not necessarily. As long as patients are ready for the procedure—in terms of overall health, at-home support, etc.—they’ll do about the same as hospitalized patients. The overall complication rate—from blood clots, joint dislocation, poor wound healing or infection—is less than 5% in both same-day and conventional hip replacements.
Who should—or shouldn’t—have same-day surgery? A patient who’s 85 years old, lives alone, can barely get around the house and has a variety of health problems would probably be advised not to go home the same day.
On the other hand, a 50-year-old who’s in great shape will probably be physiologically able to go home the same day—but you have to consider motivation, as well. It may be easier for some in a hospital, where help is a button-push away.
What about recovery? The evidence suggests that it’s about the same regardless of the type of hip replacement. You can expect to walk a bit soon after surgery, while full recovery might take three months or more. Patients may do physical therapy exercises to strengthen the thighs and hips for six weeks or more.
Do all medical centers offer same-day surgery? It’s not available everywhere, so you’ll have to ask your primary care doctor or surgeon or call around. Insurance coverage will probably be similar for inpatient and outpatient procedures.
Important: Whether or not you’re considering same-day surgery, choose a board-certified surgeon who does at least 50 hip replacements a year. Studies have found that that’s the number at which complication rates start to level off.
Also make sure that the surgeon is experienced in the same type of surgery (anterior, anterolateral or posterior) that you are getting.
To find an experienced surgeon: Check the website of the American Academy of Orthopaedic Surgeons, AAOS.org…or the American Association of Hip and Knee Surgeons, AAHKS.org.
*If you go to an outpatient center, look for one that’s affiliated with a major medical center and/or has accreditation from the Accreditation Association for Ambulatory Healthcare.
