Rohit Shishodia
Doctors have claimed that the number of joint replacement surgeries in outpatient setting is expected to surge by 50% by 2027, with same day discharge due to the latest advanced techniques, better pain management, lower cost, reduced infection rate, early mobilisation and recovery, and no need of hospitalization.  

They have pointed out that proper patient selection and education as well as multimodal protocols are all key for successful day-care joint replacement.

The doctors were speaking after successful day care hip replacement surgery of a 30-year-old woman at Apollo Hospitals, Indore, Madhya Pradesh.

The Apollo Hospitals said that the woman was suffering from severe pain in both hip joints for three years.

After the surgery, which involved replacement of the damaged left hip joint with prosthetic components, the patient was discharged from the hospital the same evening in less than 12 hours after admission.

According to the hospital, prior to the surgery, her left leg had got shortened by about 3 cm. and the pain had increased to a level that she could only walk with a significant limp.

Dr K Hari Prasad, President, Apollo Group of Hospitals, said, “With improved surgical techniques such as minimally invasive or robotic surgery and better pain management methods, there is less blood and muscle loss with faster and easier recovery, making outpatient surgery possible on some elective procedures such as knee and hip replacement.”

“Studies indicate that outpatient total joint replacement is expected to increase 457% for knee replacements and 633% for hip replacements over the next decade. By 2027, over 50% of the joint replacement surgeries will be in an outpatient setting with same day discharge. Same-day discharge joint replacement can also help reduce healthcare costs,” added Dr Prasad.

Dr Sunil Rajan, Orthopedic and Hip Joint Replacement Surgeon, Apollo Hospitals, Indore, said, “The patient was diagnosed to have Avascular Necrosis of Ball of both Thigh Bones. She was advised surgery with total replacement of her hip joints. It was decided to replace the left one first as it was more damaged.”

Dr Rajan said, “For day care surgery, complete preoperative preparation is critical for success. A team of a cardiologist and an anesthesiologist did a complete work up of the patient for fitness for anesthesia and surgery prior to admission for surgery. After their clearance, the surgery was planned for November 19, 2020.”

He further said that one day before the surgery, two of the team members went to the patient’s house to assess the facilities with special attention to height of the bed, availability of western closet and grab bar in the bathroom along with checking for any hindrance to movement with walker, amongst other aspects, to make the home ready for her recovery.

“The patient’s room and attached washroom were disinfected one day prior to the surgery and closed till she returned from the surgery. The patient and her family or attendants were trained about strict hand hygiene that they were to follow after surgery,” he added.

Rajan said, “Special precautions and medications, including adequate painkillers, were administered in view of the day care surgery and there was no use of tubes or drains. The surgery was successfully completed in less than an hour and the patient was shifted to recovery.”

“The patient was mobilized in the recovery itself with the help of a walker. She was discharged from the hospital the same evening at 5.45 PM - in less than 12 hours. One staff nurse and a housekeeping staff was provided to the patient at home for next 48 hours to take good care of her in the post-operative period,” he added.