New knees, new hips–to go

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Our 2nd Annual Innovation Issue!
Same-day Joint Replacement Steps Up

Lola Butcher

Stephen J. Zabinski, MD
Shore Orthopaedic University

New knees, new hips–to go
Bundled payment is pushing providers to look for ways to control the cost of joint replacements. Is joint replacement going to become outpatient surgery?
If you want a hip or knee replaced by Stephen Zabinski, MD, a surgeon at Shore Orthopedics Associates in Somers Point, N.J., you’re in for some homework.
If you’re a smoker, that’s got to stop; there will be no surgery if you’re aren’t nicotine-free for at least six weeks. Patients with diabetes must get their HbA1c level under control. Those with sleep apnea must document they are using the CPAP machine as per doctor’s orders. Patients with a body mass index of 45 or more must take off some weight; Zabinski’s threshold is 40 if a patient has certain comorbidities. You may need to do strength and mobility training—so-called prehab—before surgery.


Shore Orthopedics offers support for all the to-do items, but the surgeon is not going to let you off the hook. Patients must sign a contract agreeing to comply with the practice’s “total joint pathway,” and they must designate a “total joint companion” who will help them recover but also hold them accountable for following the rules. In return, Zabinski promises to get them home quickly and avoid detours to a rehab facility. He operates on Medicare patients at Shore Medical Center; some get a same-day discharge while others stay 24 to 48 hours. Most patients younger than 65 never set foot in an inpatient facility.

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