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Innovations in Modern Day Joint Replacement

If you’re worried about getting your joint replaced because you remember the experience a friend or relative went through in past years, rest assured. This isn’t going to be like your grandma’s joint replacement. Thanks to multiple recent advancements, today’s joint replacements are now safer with improved outcomes.

Discussed below are a few of the recent advancements that make joint replacement better than ever.

Benefits of Outpatient Joint Replacement

  • Shorter Hospital Stay: It wasn’t too long ago that patients spent a week in the hospital following their joint replacement.  Nowadays, for patients in good health, the average length of stay is closer to one day following surgery. It is now typical for patients to leave the hospital the morning following surgery, with many patients able to return home even the day of. Moving forward, this will allow for more joint replacements to be performed in an outpatient surgery center rather than a hospital which means cleaner, quicker, more efficient and affordable procedures.
  • Improved Pain Control Measures: One of the main reasons we’ve been able to decrease length of stay is due to improved pain control measures. From an orthopedic standpoint, we are able to minimize pain by performing less invasive surgical techniques, and working together with our anesthesia colleagues to utilize more effective medication strategies.
    • Multimodal Pain Regimens: It turns out that using multiple different types of pain medications, each with a unique mode of action, is much more effective than the old method of simply giving more and more narcotics until the pain subsides, at the expense of side effects such as drowsiness, altered mental status, and constipation. Multiple types of pain medications are administered prior to surgery, and then continued postoperatively. As a result, narcotic usage has significantly decreased and overall pain scores and satisfaction have improved.
    • Regional Anesthesia: In general, all patients are completely sedate throughout surgery, either under general anesthesia or under spinal with sedation. However, regional nerve blocks that numb the sensory nerves around the surgical site are given to significantly lessen pain following surgery, which is particularly useful for knee replacement surgery.
    • Local Anesthetics: Though it seems like a basic idea, local anesthetics were not typically injected into the surgical site during joint replacements until the past few years. Now, routine use of local anesthetics (numbing medicine like lidocaine), injected directly into the tissue that are disturbed during surgery, allows for an even greater extent of pain control.
  • Minimally Invasive Surgery (MIS): Incision length isn’t everything – surgical exposure needs to be sufficient to get the job done well. However, as surgical techniques, technology, and instruments have improved, we are now able to do better surgery while minimizing damage to surrounding structures. For example, Direct Anterior hip replacements have been shown to have quicker initial recovery compared to other contemporary hip approaches. Such options can result in quicker recovery, less pain, and improved patient satisfaction.
  • Reduced Need for Blood Transfusions: Blood loss leads to light-headedness, weakness, and slower recoveries following surgery. While blood transfusions were historically given at a high frequency following joint replacement to combat these effects, blood transfusions are disconcerting for patients and predispose to systemic illness, infection, and allergic reactions. Fortunately, blood transfusions are now a rarity following primary joint replacements. This is due to routine use of anti-fibrinolytic medications which minimize intraoperative bleeding as well as more strict transfusion criteria.
  • Easier Perioperative Care and Patient Education: Prior to joint replacement, all patients are encouraged to attend education classes. These classes are used to review instructions for perioperative care. The importance of knowing what to expect and minimizing postoperative surprises once you get home from the hospital cannot be understated. At ROC, joint classes are offered every Wednesday, lasting less than an hour, and are very helpful for patients as well as the family members helping to take care of them after surgery. A few examples of how postoperative cares have improved are listed below:
    • Blood Thinners: While blood clots remain a possibility following joint replacement surgery, for low-risk patients we now routinely use simple aspirin for blood thinners following surgery. Strong blood thinners like Coumadin (Warfarin) and injected heparin products are no longer necessary for most patients. This results in fewer bleeding complications, less need for laboratory monitoring, and less hassle overall.
    • NPO Status: While it is still important for patients to avoid solid foods for 8 hours prior to surgery, we now encourage patients to continue drinking clear liquids up until a couple hours prior to surgery. This allows for improved patient comfort as well as fewer issues with dehydration, nausea, and light-headedness following surgery.
    • Bandages: It seems like a trivial matter, but today’s bandages are different too. Occlusive dressings allow for easier postoperative hygiene and don’t need to be changed as frequently as the tape and gauze of the past.