Outpatient Hip Replacement

Hip replacement surgery that allows the patients to go home the same day of the surgery is known as outpatient hip replacement surgery. With the advances in hip replacement, the risks associated with hip replacement surgery have decreased significantly. Medically healthy patients who may need a hip replacement surgery may benefit from a same-day discharge to home.

X-ray showing a total hip replacement.

While outpatient hip replacement surgery offers several advantages, not all patients may be candidates for outpatient hip replacement. Candidates for outpatient hip replacement surgery are:

• Ideally, non-smoker as smoking is associated with increased risk of wound non-healing and increased postoperative pain.
• Free from major medical illnesses such as diabetes, cardiovascular diseases such as coronary artery disease, or lung diseases such as COPD.
• Generally, outpatient hip replacement is only advised in patients who are physiologically 70 years or less.
• The candidates for outpatient hip replacement surgery may need a social and family support system at home.
• Patients with a history of illicit drugs are poor candidates for outpatient surgery as their postoperative pain management may be complicated due to prior drug abuse.
• Candidates for outpatient hip replacement usually are not obese or overweight.

Outpatient Hip Replacement Procedure

The patient’s entire health care team regarding the patient’s suitability for the outpatient surgery. The patient’s primary care physician, anesthesiologist, and pain management physicians work along with the surgeon to determine the best course for the patient’s surgery.

The patient is advised to make accomodations at home for his/her return the same day of the surgery. The accommodations may include stocking food supplies, toiletries, and if possible to have living quarters in the same floor of the kitchen and the toilet.

The surgery may be done at an outpatient surgical center or a hospital. The surgery usually involves an approach through the side of the hip. After a general anesthesia the surgeon gives a 8-10 inches of incision and separates/cuts the tissues and muscles to reach the hip joint. The surgeon then proceeds to remove the diseased head of the femur and shaves the diseased inner part of the acetabulum.

The surgeon then places a prosthetic metal alloy cup in the socket and usually secures it with one or more metal screws. The canal of the femur is serially reamed to prepare it for the metallic femoral component. After trial of implants and selecting the right size of implant, the surgeon press fits the implant in the canal.

A polyethylene spacer is placed in between the head and the socket for smooth gliding of the prosthetic joint. The incision is then closed in layers and a sterile dressing is placed on the surgical wound. The patient is then taken out of the anaesthesia and administered appropriate pain relief medications.

The patient is continuosly monitored in the postoperative room. The patient is given detailed instructions regarding the hip replacement precautions which may include:

• Use of abduction pillow when lying down and sleeping.
• Not cross the legs while sitting, lying or standing.
• Not twist on the operated leg.
• Not to turn the leg/foot on the operated side inward.
• Surgical wound/dressing care.

The patient is also advised in detail regarding any possible complications and how to reach for help. The possible complications, although rare, may include blood clots in the legs, breathing problems, heart problems, infection, bleeding, fracture, etc.

The patients are also advised in detail regarding expected postoperative pain and it’s management. The use of compression stockings and measures to reduce swelling. Thorough instructions are given regarding walking after replacement and the use of walking aid to prevent accidental slip and fall.

A nurse and a therapist usually visit the patient at home to assess their recovery, change dressing if necessary and guide the patient regarding exercise. Should any complication arise, the patient may be admitted to the hospital.

Instruments used in a total hip replacement.

Advantages

The outpatient hip replacement offers rehabilitation in the comfort of the patient’s own home. The patients often find their home environment more reassuring and convenient than a hospital. The outpatient surgery has been linked with better participation in physical therapy. The outpatient hip replacement also decreases the chances of hospital acquired infections. An outpatient surgery is potentially associated with a decrease in health care burden and costs.

Disadvantages

The patients may feel more secure staying at a hospital where medical help may be more readily available if needed. Pain management may be better in an in-hospital setting. Even when a patient is considered a safe candidate for outpatient surgery, complications may arise and lead to admission in a hospital.

Conclusion

Hip replacement surgery techniques and implants have advanced in the past decades that the complications associated with the surgery are rare. The complications are more predictable and the pain management has evolved to be tailored according to each patient’s needs.

A greater number of patients are being offered outpatient hip replacement surgery today. Even if patients are not candidates for outpatient surgery, patients usually tend to stay only a night or two depending upon their medical conditions. Speak with your orthopedic surgeon if outpatient surgery may be suited in your case.