Joint replacement surgery without the hospital stay

PITTSBURGH – Imagine going to sleep with chronic joint pain, waking up without pain and walking out of the hospital the same day.

For Daniel Currie, 57, of Franklin Park, Penn., this was no dream. After suffering with osteoarthritis for more than a decade, Currie had a three-hour hip replacement surgery and was discharged from West Penn Hospital hours later. He is one of a growing number of people having same-day joint replacements.

"When I woke up, it was wonderful," he said. "Typically I feel pain all the time, so waking up without pain from a night where [I could] barely sleep was wonderful."

Joint replacements are a way to treat advanced arthritis that has not responded to nonsurgical treatments such as anti-inflammatory medication and activity changes, said Dr. Michael Seel, director of orthopedic surgery at West Penn Hospital.

Both knee and hip replacements typically require an average hospital stay of two to three days.

A year and a half ago Allegheny Health Network began offering same-day total hip replacements. In May, the first same-day total knee replacement was performed at Allegheny General Hospital. "This is phenomenal, and it's because of the baby boomers," said Nick Sotereanos, the orthopedic surgeon who performed Allegheny Health Network's first same-day hip replacement. "There is a huge economic push to make this procedure less expensive and quicker."

Seel said the surgical technique is the same for same-day patients and overnight patients. But improved surgical and pain management techniques have enabled some patients to avoid a night in the hospital.

More than 600,000 knee replacements are performed each year in the United States, according to the Agency for Healthcare Research and Quality.

More than 90 percent of patients who have total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living, said the American Academy of Orthopaedic Surgeons website.

Several studies show that same-day joint replacements can yield successful results if they are done on the right patient using a well-executed technique.

Good candidates for same-day joint replacements are in their 60s or younger and lack other health problems, such as heart disease, Seel said. Patients are discharged only if they can walk with assistance 40 and 75 feet — about the length of a city bus or longer — and get out of bed, use the bathroom and go up and down a flight of stairs unassisted. "It doesn't cost any more, the quality is identical, and we wouldn't have it any other way," Seel said, adding that implants can last up to 20 years.