Outpatient Joint Replacement During A Pandemic

This article is part of the Ultimate Guide to Hip Pain Relief.

Joint replacement surgery can be intimidating as it is, add in the fear associated with COVID-19 and surgery feels even more scary. While the pandemic has brought about new questions and concerns regarding surgery safety, many patients are proceeding with joint replacement to improve their quality of life. Now more than ever patients are seeing the benefits of outpatient joint replacement.

IBJI’s Dr. Brian Schwartz, answers common questions when it comes to joint replacement and the benefits of choosing outpatient joint replacement surgery during the pandemic. Dr. Schwartz is a board-certified orthopaedic surgeon, fellowship-trained in hip and knee reconstruction and outpatient hip and knee replacement. His responses—below—have been edited and condensed for space.

Frequently Asked Questions About Joint Replacement During the Pandemic

Should I schedule a joint replacement surgery during COVID-19? Or should I wait?

Dr. Schwartz: If your pain is leaving you immobile, we recommend discussing your options with your physician. Typically, non-operative management is the first line of treatment but once this fails, surgery may be considered. Sometimes waiting too long for joint replacement can have negative consequences leading to diminished outcomes or making the surgery more complex.

Surgery centers and hospitals are taking extra precautions to make the surgery a safe experience. Most health care staff are now receiving COVID-19 vaccines and everyone stepping foot into health care settings are screened for COVID-19 symptoms.

What is outpatient joint replacement?

Dr. Schwartz: Outpatient joint replacement, also known as same-day surgery, is an alternative route that patients can take to avoid an overnight stay at the hospital post-surgery. This option allows the patient to receive joint replacement surgery in an ambulatory surgical center, and returning home in under 24 hours (often times as early as four to six hours from surgery). This is especially important in the COVID-19 pandemic and allows for patients to undergo a joint replacement without having to step foot in a hospital.

Do I need to go to the hospital for surgery?

Dr. Schwartz: It depends on the patient. Not all patients are candidates for outpatient total joint replacement. The pandemic has vastly accelerated the number of patients that are seeing the benefits of outpatient joint replacement.

Who meets the requirements and indications for outpatient total joint surgery?

Dr. Schwartz lists the factors that are taken into account.

1. Motivation and Support: The patient must be motivated and have a good support system at home. It is very helpful to have a friend or family member that can assist you in the immediate post-operative period.
2. Overall Good Health: Overall good health is suggested for outpatient surgery. A hospital setting may be recommended for patients with serious medical conditions such as poorly controlled diabetes, severe sleep apnea, significant cardiac pulmonary or renal disease.
3. Age: Age is also a factor but does not necessarily preclude you from outpatient joint replacement. Traditionally, this was reserved for younger patients but we are now seeing patients in their later 70’s undergoing successful outpatient hip and knee replacements.

What are the benefits of outpatient joint replacement?

Benefits of outpatient joint replacement include the following:

1. Lower risk of COVID-19 exposure: Unlike hospitals, surgery centers have no inpatient wards and therefore have no inpatients with COVID-19.
2. Lower infection risk: Outpatient joint replacement in free standing surgery centers may offer a lower risk of infections of the hip or knee replacement. Typically, only healthy patients undergoing orthopedic procedures are done in IBJI affiliated centers versus hospitals that have all sorts of other procedures being performed. In 2020, at our local surgical center we had a zero percent infection rate for hip and knee replacements.
3. Lower cost: The overall cost of the procedure done at a surgery center is typically a fraction of the cost of having the exact same procedure with the exact same surgeon at a hospital. 
4. Comfort: Getting back to every day life sooner by going home the same day and recovering in the comfort of your own home.
5. Quality care: Everyone involved in the process provides quality care from check-in, to surgery and the home health care nurses and physical therapists that visit post-operatively. The surgeons having a say in the staff that are involved in their patients care provides a higher level of personalized patient care.

Read our blog on Benefits of Outpatient Joint Replacement

Is outpatient joint replacement just a fad that will fade away after the pandemic is over?

Dr. Schwartz: No, outpatient joint replacement is here to stay and will likely only grow in the coming years. Given the benefits there is an alignment of interests from patients, physicians and insurance companies that will lead to significant growth of outpatient joint replacement.

When should I consider a joint replacement?

Dr. Schwartz: IBJI’s physicians and surgeons will recommend joint replacement when pain becomes so unbearable that it begins to restrict your range of motion, activity level and affects your daily life. Typically, patients are treated with non-operative measures first. These include activity modifications, pain medications such as non-steroidal anti-inflammatories, physical therapy, bracing, assistive devices such as a cane, weight loss and injections. If the pain and disability do not get to a tolerable level with non-surgical management then surgery may be the best option.

Is physical therapy prescribed after joint replacement? Is physical therapy safe during COVID-19?

Dr. Schwartz: Physical therapy will be prescribed after your joint replacement. Physical therapy helps you to regain mobility and function after surgery. Our highly-trained physical therapists will teach you exercises and movements that will help you heal in order to get you back to your daily activities.

Physical therapy is safe during COVID-19 as IBJI has implemented a number of new COVID-19 safety procedures including, but not limited to, pre-screening all patients with COVID-19 questions, masking, social distancing, limiting the number of patients in the office, and continuous daily cleaning of all surfaces and equipment.

What is the Goal of Physical Therapy?

Scheduling a surgery such as outpatient joint replacement requires a lot of decision making that should take place between you and your physician. Outpatient joint replacement is not recommended for every patient. We recommend discussing your options and questions with a physician to make the best choice for you.

For more information on joint replacements, read our Hip & Knee Replacement Patient Education.

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