Get a new knee that morning, go home that afternoon

Sept. 9, 2019
By 2025, it is estimated CMS will mandate that between 30 percent and 50 percent of all replacement knees and hips should be done same-day

Selected patients are now receiving same-day knee replacement surgery in the Department of Orthopaedic Surgery at University of Alabama (UAB) at Birmingham and going home that afternoon.

This is a change in practice that has been evolving over time. Twenty years ago, knee replacement patients would remain in the hospital for four or five days. As recently as two years ago, a patient could expect to stay three days. Patients do have to meet certain criteria to be eligible for the same-day discharge. 

“For some patients, an overnight stay in the hospital is not necessary,” said orthopaedic surgeon Elie Ghanem, MD in a news release. “The sooner patients can return home and return to their normal routine, the better. We want patients to go home and be active through physical therapy, and not be in ‘sick’ mode at the hospital.”

Ghanem points out that reducing hospital stays reduces the risk of an acquired infection, adding that “Advances in anesthesia are a large part of why we can offer same-day surgery now. Our collaborations with physical therapy, nursing and anesthesia are the keys to making the program work. And the patient and family have to be on board. Most are excited to be able to go right home.”

“There is exclusion criteria,” Ghanem said. “Patients with heart issues, such as arterial fibrillation or coronary heart disease, are not eligible. Lung issues and a history of prior infection would also rule a patient out. And patients need to have social support in place at home.”

Due to travel concerns, the program is limited to patients living within a 90-minute drive to UAB Highlands Hospital. Patients will receive two or more physical therapy sessions following surgery. They must be medically stable, have pain under control and be able to walk 150 feet to be eligible for same-day discharge. Ghanem says most cases are done under spinal sedation, not full anesthesia.

Currently, same-day discharge is available only for patients undergoing total knee replacement, but UAB is working to develop the same program for total hip replacement.

“It is estimated that, by 2025, the Centers for Medicare and Medicaid Services will mandate that between 30 percent and 50 percent of all replacement knees and hips should be done same-day,” Ghanem said. “Our pain management protocols, anesthesia techniques, dedicated orthopedic nurses/therapists, and selection criteria have made our program possible and safe for a large percentage of our patients.”

UAB Medicine’s joint replacement team performs more than 1,000 hip and knee replacements annually, and that number continues to grow.