The Revolution of Same-Day Joint Replacement Surgery: Q&A with Dr. James T. Caillouette

Joint replacement has been undergoing a revolution in recent years, and Hoag Orthopedic Institute and its orthopedic surgeons are on the forefront of that change, leading the way for same-day joint replacement surgery since 2008. We spoke with James T. Caillouette, M.D., a founder of Hoag Orthopedic Institute and renowned orthopedic surgeon who specializes in hip and knee surgery, about the evolution of joint replacements and its impact on patients’ recovery.

Q: What is the difference between inpatient hospital and same-day joint replacement surgery?

A: For the majority of patients who undergo an elective procedure such as a hip or knee replacement surgery, they would be admitted to a hospital, and after joint replacement surgery, would spend up to a day or two in the hospital recovering before being sent home or, if necessary, to a step down facility to recuperate. Patients undergoing same-day surgery could be admitted to a hospital or an ambulatory surgery center and then be discharged less than 24 hours after their surgery. Years ago, when I was an orthopedic surgery resident, for example, patients undergoing joint replacement typically would spend up to seven days in the hospital before going home. Today, I have patients that come in at 7 a.m. and are up and walking after surgery ready to go home in the late afternoon. There has been a revolutionary shift in the technique, anesthesia and process of joint replacement surgery to shorten the length of stay in a hospital or surgery center and return the patient home as soon as medically appropriate.

Q: Is same-day joint replacement surgery available to anyone?

A: No. Patient selection for same-day joint replacement surgery is of paramount importance. Ideally, younger patients that are in good overall health, engaged and committed to their surgical journey and have a support system at home while they recover can receive same-day joint replacement surgery. Some older patients or those who have chronic health conditions such as diabetes, certain heart ailments, COPD or have a high BMI (body mass index) and don’t have a support system at home may not be candidates for same-day joint replacement. If you are generally fit, younger and in good general health, you are an ideal candidate for same-day surgery.

Q: Are the results of same-day surgery the same?

A: Yes, and perhaps even better. There has been a lot of medical research into the outcomes of same-day joint replacement surgery and the findings, in general, are that patients fare better when they go home the day of their joint replacement surgery. The studies found that same-day joint replacement patients experience fewer complications, including a lower infection rate. Moreover, patients themselves report a high degree of satisfaction and better outcomes with their same-day surgery experience. In most of our same-day surgery patients, we get them up and walking within hours of their surgery. Motion is life.

Q: How long have you been performing same-day joint replacement surgeries?

A: We did some of our first same-day surgeries more than a decade ago and each year since then we’re doing more on a same-day basis. At Hoag Orthopedic Institute (HOI), we helped pioneer the concept of “bundled” payments for joint replacements. Under this scenario, companies pay one set fee for the episode of care for their employees for joint replacement. To save costs for the employer and patient, we began performing joint replacements same day for those who met the criteria.

Q: Does same-day surgery carry risks?

A: All surgeries carry some risk, and these risks should be discussed in detail with your doctor. All in all, there is no additional risk by having same-day surgery. However, some patients don’t like the idea of being rushed home. Recovery can be taxing. Same-day surgery does not offer the round-the-clock care for a few days that you would receive in a hospital setting. The key is preparation: the more you can do before your surgery to prepare for when you get home the better. Most importantly, you need good at home support from a family member or caregiver to help you through your rehabilitation.

Q: Why is same-day surgery a growing trend?

A: Innovations in the surgical approach to hip and knee replacements are part of the drivers behind the trend. Couple this with newer and improved anesthesia and pain management techniques as well as accelerated and customized physical therapy regimens and the result is a revolution in joint replacement surgery. To date, HOI has performed more than 1,000 same-day joint replacements. Most experts predict that by 2027, 50 percent of all joint replacements will be performed on a same-day basis in the U.S.

Q: Why the rush to get the patient home quickly?

A: Hospitals, even the best ones like Hoag Orthopedic Institute, are not the same as your home and your own bed. When we send patients home the same day, they are already performing physical therapy through Hoag’s Enhanced Recovery Program. Even with help, they are walking and putting weight on their new knee or hip. At your own home, you are around your own germs, so the risk of infection is reduced.

Q: Does same-day surgery costs less?

A: Yes, but it really depends on your health insurance benefits. Same-day joint replacement surgeries are typically less expensive than an inpatient overnight hospital stay; moreover, having your surgery performed in an outpatient surgery center may reduce the cost of the surgery significantly, again, depending on your benefits.

Q: What are the best criteria to review to determine if your surgeon is experienced in same-day joint replacement surgery?

A: I would encourage you to ask about the surgeon’s and hospital’s experience with same-day joint replacement surgery. Studies have indicated that the more same-day joint replacement surgeries you perform, the better your results. I would also ask if they collect and publish outcomes for patients to review. You can review our results at www.hoioutcomes.com

(James T. Caillouette, M.D., is the founding partner, Chief Strategy Officer and The Joan and Andy Fimiano Endowed Chair in Orthopedic Surgery at Hoag Orthopedic Institute).