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It’s time to change our thinking about joint replacements

For many years, joint replacement surgery was a major operation performed only in a hospital. Not anymore. Thanks to advances in surgery, anesthesia, and post-operative care techniques, it’s often preferable for healthy patients to have surgery in an outpatient facility and go home the same day.

In fact, as a hip and knee surgeon, one of the assumptions I most want to change is that joint replacements require an overnight hospital stay. That’s no longer true. Individuals can have a safe and gratifying experience as an outpatient.

Home is where the recovery is

Compared with patients who stay overnight in a hospital, patients who have a joint replaced in a surgery center experience several benefits. They get to go home and sleep in their own bed, enjoy their own food, and recover comfortably in their own environment. Patients tend to be more active, which speeds their recovery and helps their new joint function well in the long-term.

Furthermore, surgery center procedures are typically more affordable than multi-day hospital stays. In Southwest Washington, our local hospitals and staff carry a heavy load and operating rooms are in high demand. Frequently, surgery may be scheduled faster outside of the hospital.

Stellar pain-management options

What’s more, patients receive excellent care in both settings. Patients who have an outpatient joint replacement don’t experience worse pain than patients in a hospital. Surgery centers often employ regional nerve blocks that lower pain levels and reduce the need for narcotics. Some patients even say that they prefer the pain-control options of the surgical centers over the hospital choices. Patients who have same-day surgery can also be confident that there is a substantial body of scientific evidence supporting the safety of outpatient surgical care.

Total Joint Program offers smooth experience

We’ve seen these benefits firsthand at Vancouver Clinic, where we offer a Total Joint Program. Patients in our program have a full team of people behind them to ensure they are cared for at every step.

In addition to their doctor, patients work with a joint coordinator who answers questions, provides education classes, and lines up the proper pain medications. Clinicians evaluate patients’ health to make sure they are ready to undergo surgery. Our team also schedules follow-up and physical therapy appointments far in advance so that patients know what to expect during their recovery.

Leading disinfection method

With the opening of our Salmon Creek 2 Clinic, all our outpatient joint replacements take place in our new, state-of-the-art surgery center. The surgery space includes 18 private pre- and post-procedure rooms. Six operating rooms feature Indigo-Clean technology, a visible light disinfection device that kills the flu, COVID-19, and other bacteria and viruses both in the air and on surfaces.

Total hips and knees, the easier way

The technology surgeons use during joint replacements is one of the factors that make the procedures viable outside the hospital. At Vancouver Clinic, my colleagues and I perform Mako™ robotic-assisted total and partial knee replacements. Robotic-assisted surgery techniques allow us to reduce soft-tissue trauma and place implants with tremendous accuracy to better recreate natural movement.

For hip replacements, I offer two approaches: a minimally invasive direct anterior approach that relies on the VELYS™ hip navigation system and a special operating room table, and Mako™ robotic-assisted posterior approach total hip arthroplasty. The direct anterior approach allows me to replace the hip joint through a small incision—without cutting any of the muscles around the hip. This leads to a slightly faster recovery.

I collaborate with each patient to choose the best and safest surgery option for them, balancing individual needs, recovery time, and expected results. I love teaching patients about what will happen during their surgery because I think that knowing more of the details gives them confidence in their body’s ability to heal.

Patients drive decisions

While outpatient surgery is a fantastic option for many patients, the right place for surgery depends on the individual. A patient’s diagnosis, underlying conditions, overall health, support system, and personal motivation are all factors that physicians consider.

Joint replacements are getting easier on patients, yet it’s still major surgery. I always work with patients to exhaust other pain-management options—including injections, weight loss, and low-impact physical activity—before recommending a full replacement. Because a new joint is not native anatomy, the patients who are most satisfied with surgery are those who previously experienced consistent debilitating pain.

For those patients, however, a new joint can be life changing. Witnessing the joy people feel when they can return to doing the activities they love is what inspired me to enter medicine. In my mind, there’s no greater calling than helping people move their bodies freely.

Dr. Michael Kahan is a Vancouver Clinic orthopedist who specializes in minimally invasive hip and knee surgeries. He uses a holistic approach to patient care and takes the time to educate individuals about evidence-based treatment plans so they can make informed decisions.