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Same Day Surgery for Total Hip Replacement

Lawrence D. Dorr, M.D.

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Dr. Lawrence D. Dorr

Lawrence D. Dorr, M.D. Same day surgery for total hip replacement means that patients are admitted into the hospital in the morning, have the operation early in the morning, and are discharged to home that afternoon between 4:00 and 6:00 p.m. Currently, we are using same-day discharge for patients that are under the age of 65, are healthy, and desire to do this. To-date, only patients with a posterior lateral incision have been included in the same day discharge. However, it has been done at other centers with the two-incision technique which is used by Dr. Berger in Chicago and Dr. Duwelius in Portland as two examples. I believe that the same day discharge is the single best expression of the new process of total hip replacement. For me, it really exemplifies the improvements in total hip replacement with the surgical technique and patient care. I remember when I started my career with total joint replacement in the late 1970s and early 1980s and at that time we would admit patients two days before surgery and they would remain in the hospital for two weeks after surgery. How exciting it is now that patients can go home the same day! Some people, and even some doctors, ask the question why would patients go home the same day? Mostly, as has been the nature of man throughout our history, the answer is because it can be done! But the important fact is that it can be done safely as has been clearly demonstrated due to the experience of Dr. Berger and as we have seen with our experience over the last six months. Patients can go home because of the new anesthesia and pain management techniques that we use and the less invasive surgery that the posterior mini incision affords (see the web site and see the results of the gait analysis for function with the posterior lateral in the article in this Joint Journal by Sam Ward, Ph.D.) I believe patients experience a huge elevation of their spirit in realizing how well they can do by the same day discharge. The patients that go home with the same day discharge are usually those who take pride in their ability to have some control over their situation and who recognize that their ability to go home on the same day represents success to them. The ability to go home the same day of surgery increases the confidence of the patient in their outcome and will help them feel, throughout time, that they have a successful result and will allow them to realize their expectations with their hip replacement. This same day discharge is the quintessential example of how research can improve the patient care and patient outcomes with total hip replacement.

Patients can go home the same day! Scientific data for small posterior lateral incisions, that has been based on the classic methodology of data collection for total hip replacements, has not shown clear-cut differences between long and short incisions. Some objective data is emerging with the use of gait analysis (see the research report by Sam Ward, Ph.D). It has become clear to the orthopedic community that the claims of proponents of anterior, posterior, and two-incision operations are those of emotional bias. All the incisions seem to work essentially equally. The avoidance of any muscle being cut has had no effect on outcome (again, see gait research). What has been shown to be clear in our research is that the small posterior lateral incisions do give a better early functional result than long incisions. The singular most important change in the surgical technique for improvement of the results with total hip replacement has been the use of the computer navigation for total hip replacement. The computer navigation allows nearly perfect mating of the cup and stem and this prevents impingement of the implants which reduces pain, is the most important factor for stability (prevention/dislocation), and promotes long term durability.

I think the lesson I have learned the most in the research that we have done with the small incision surgery is the importance of the mental attitude of the patient to the outcome of the operation. This mental aspect of the operation has really been ignored by orthopedics until the last two to three years. It is truly impressive to see how effective the mental approach of the patient to his/her operation can affect the short term outcome and confidence in the long term outcome. For those patients who do go home on the same day, their ability to minimize the economic impact of the operation, to minimize the disruption of their home and family life, and to maximize their early function is really the reason that they prefer this process and that the process is beneficial for them. I am proud of the contribution of the Dorr Arthritis Institute to the new process of total hip replacement and to the advent of same day surgery.

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