What You Should Know about Outpatient Hip and Knee Replacement

Alexander P. Sah

Same-day and next-day discharge home after joint replacement requires optimal pain management, blood-sparing techniques, and advanced rehabilitation protocols. My interest in rapid recovery joint replacement evolved from continued modifications I made in my protocols to minimize post-surgery pain, to reduce medication side-effects, and to speed recovery. Plus, these advancements benefit not only my outpatients, but all surgical patients including the complex and revisions.

With careful and gradual advancements, in 2014, I initiated a new protocol at the Institute for Joint Restoration involving same-day ambulation in all of my joint replacement patients and next-day discharge (total knee, total hip, and revision hip and knee patients). Partial knee replacement patients were able to go home the same-day as surgery. This evolution took time, patience, research (see presentations below), and careful adaptation. While a significant change from the prior successful protocols, and initially met by staff resistance, the patients proved that recovery is faster and satisfaction greater with these protocols.

In addition, in 2014, I created and serve as Director of the Outpatient Joint Replacement Program at the Washington Outpatient Surgery Center. Here, in addition to same-day partial knee replacement surgeries, I am the only surgeon at the Institute to perform outpatient total hip and total knee replacement surgeries for select patients allowing them to go home the day of their joint replacement surgery. The success of this program is a combination of optimal pain management, blood-sparing techniques, and advanced wound management.

Another recent advancement in hip surgery is anterior hip replacement. As the only surgeon at the Institute providing this service, I have spent time learning, training in, and researching the anterior approach to provide its possible benefits to select patients. Patients have seemed to recover even faster compared to traditional hip replacement patients.

I have enjoyed the process of evolving my protocols and lecturing surgeons, serving as faculty at meetings, and collaborating with other national leaders in this outpatient arena. I will continue to advance these techniques in the hope of optimizing my patients’ experience.

Patient 10 days after outpatient total hip replacement.

Walking day of total knee replacement leaving Surgery Center, followed by her 10 day visit after surgery.

Patient 10 days after outpatient total knee replacement, and 6 weeks after outpatient total knee surgery in other knee.

Presentations
 
Alexander Sah, “Tackling the Outpatient Total Knee Replacement- Challenges and Obstacles”
Presentation at Symposium, AAHKS, Dallas, 2017
 
Alexander Sah, “Moving to the Outpatient Setting: Opioid-sparing multimodal protocols in total joint arthroplasty”
Presentation at Symposium, AAHKS, Dallas, 2017
 
Alexander Sah, “Outpatient Joint Replacement: Practical guidelines for your program based on evidence, success, and failures”
Moderator of Instructional Course Lecture at AAOS Annual Meeting, New Orleans, 2018
 
Alexander Sah, “Same Day Surgery- Top 5 Tips for Outpatient Joint Replacement”
Presentation at CA Orthopedic Assoc Annual Meeting, Carlsbad, 2017
 
Alexander Sah, “Optimizing Pain Management for Outpatient Joint Replacement”
Presentation at CA Orthopedic Assoc Annual Meeting, Carlsbad, 2017
 
Alexander Sah, “Initial experience with nonselective patient next day discharge after total knee arthroplasty”
Poster at AAHKS Annual Meeting, Dallas, 2016
 
Alexander Sah, “Outpatient Joint Arthroplasty- Postop considerations and preventing readmissions”
Presentation at Road to Outpatient Joint Replacement Symposium, AAHKS, Dallas, 2016
 
Alexander Sah, “Rapid Recovery Joint Arthroplasty”
Presentation at 25th Annual California Orthopedic Association meeting, Laguna Niguel, 2016
 
Alexander Sah, “The Road to Outpatient Joint Replacement”
Presentation at Contemporary Solutions in Joint Surgery, Newport Beach, 2016
 
Alexander Sah, “Patient Selection- Choosing the Right Patient for Outpatient Surgery”,
“Preoperative Education- Setting yourself up for Success”,
“Pain Management- Protocols allowing Rapid Recovery and Early Mobilization”,
“Post-discharge Care- Creating the Safety Net”,
Presentations at Team Approach to Building an Outpatient Joint Program, Chicago, IL, 2016
 
Alexander Sah, “Economics of TJA, Rapid Recovery, Outpatient Joint Replacement”
Panel at 4th Annual VuMedi- The Event, San Francisco, 2015