Hip replacements move to outpatient-style model
Hip and knee replacements have come a long way in Dr. Stephen Zabinski’s career as an orthopedic surgeon.
But one advancement is something unheard of 20 years ago – patients getting hip replacements in an ambulatory surgical center in the morning and returning home early in the afternoon.
This approach avoids possible days-long recoveries in a hospital and rehabilitation center, ultimately making it more cost effective for health care reform, he said.
“It really achieves all the goals we want to provide better care to patients in a safe way that’s more cost effective,” said Zabinski, who is the director of the Division of Orthopedic Surgery at Shore Medical Center and President of the Jersey Shore Ambulatory Surgical Center.
The hip replacements use a “direct anterior approach” that avoids cutting muscles to put the hip implant in, he said.
The procedure still cuts bone and puts in implants, but avoiding slicing muscles gives patients less pain and more mobility at home, he said.
“A lot of these hip patients because you’re staying away from these muscles, you don’t need crutches or a walker, you can just use a cane,” he said.
Knee replacements, likewise, do not cut the quadriceps muscle, but instead involve sliding the muscle over.
Performed outside of the hospital, the surgeries involve several hours of recovery, a physical therapist’s help at the surgical center and usually a return home by 2 p.m.
Visiting nurses and physical therapists then return to the home for about a week before patients can get treatment at outpatient therapy.
Zabinski said this home-based approach is suitable for about 20 percent to 25 percent of patients.
It is not based necessarily on age, but physical health, muscular build, medical history and the ability of patients to get help from loved ones at home, he said.
He said the approach meshes with where healthcare reform in going in the U.S.
A recent study by the American Academy of Orthopaedic Surgeons indicates about 2 percent of Americans are living with artificial joints.
The numbers of these surgeries are anticipated to grow significantly over the years. A study in the Journal of Bone and Joint Surgery found increasing total knee replacements strongly tied to obesity trends in the U.S., particularly with younger patients.