Broad study on outpatient total joint replacement surgery reveals exceptional results, bolstering Bucks County Orthopedic Specialists’ exclusive Heal@Home program.
In 2017, following a rigorous application and review process, Bucks County Orthopedic Specialists (BCOS) was the first practice in Eastern Pennsylvania to gain approval from the state to perform total joint replacement surgery in a freestanding joint replacement center, with no hospital stay required. Since then, the program, known as Heal@Home, has grown exponentially. In fact, over 1600 successful outpatient total joint replacement surgeries have been performed by BCOS surgeons at two different locations in Bucks County.
While our surgeons have seen firsthand that their Heal@Home patients are recovering quicker with fewer complications, a broad new scientific study in The Journal of Arthroplasty (the leading journal for joint replacement surgeons) validated their anecdotal experience.
We recently sat down with Dr. Thomas Vikoren, one of the lead pioneers of the innovative surgery in PA, to discuss the results of the study, the success of BCOS’s Heal@Home program, and what patients can expect from outpatient total joint replacement surgery.
What is Bucks County Orthopedic Specialists Heal@Home program?
Heal@Home is the name given to our outpatient total joint replacement program. It is a revolutionary program that allows patients to have a total hip, knee, or shoulder replacement in the morning and be home by the afternoon.
Why is the study on outpatient total joint replacement surgery in “The Journal of Arthroplasty” so significant?
It validates the success of Heal@Home that we see in our patients. We’re doing more and more of our total joint replacements on an outpatient basis, meaning that the individual has surgery, goes to the recovery room, immediately starts physical therapy, and is able to go home shortly thereafter.
The study, which was published November 2021, evaluated 86,000 people who had joint replacement and any complications, based on the “length of stay” that they had for the procedure. They compared data for patients who had the outpatient procedure to those who had an overnight hospital stay, and those with a multi-day hospital stay. They found that the complication rate was the lowest by a statistically significant margin among those patients who went home the very same day as their joint replacement surgery.
Why do you think there are fewer complications for same-day total joint replacement patients versus those who stay overnight or for several days in the hospital?
There are a few factors. But one of the main ones is that the immobility of being in the hospital, not moving around, raises the risk those complications. For example, when someone has surgery and then they lie in a hospital bed, they are more prone to develop blood clots. But, with outpatient surgery, people are up and walking much more quickly, which promotes blood flow, thereby reducing that risk.
In addition to the lower complication rate, what else would you say are the benefits of outpatient joint replacement surgery?
I think people recover faster because they’re up and walking. They also have a different mentality. It is not a mentality of illness and convalescence, but rather a mentality of movement and physical therapy, which is the best thing for it.
Why is mobility so important after joint replacement surgery?
Besides reducing the risk of blood clots, movement also helps with the stiffness, which can lead to excess scar tissue formation. If you keep moving the joint from the very beginning, it can greatly reduce all of those things.
How do patients react when you tell them they can have a total joint replacement and go home on the same day?
One of the most common things I hear is that when my patients tell their friends that they are having a joint replacement and going home on the very same day, their friends ask, “is that possible?!” Of course, I educate patients on our practice and that we are the first and largest program in the eastern half of Pennsylvania for outpatient total joint replacement. I also share my observations on how well people do with outpatient total joint replacement. Then it’s always nice when studies validate the observations you’re making when they have been conducted on a larger scale. So, the study in Journal of Arthroplasty is really important.
In Bucks County, where are the same-day total joint replacement surgeries performed?
We are currently running the Heal@Home program at both Doylestown Hospital, and at our free-standing surgical center, Bucks County Surgical Suites (BCSS) on Easton Road in Warrington, which is specifically dedicated to outpatient surgeries. For patients who have surgery at Bucks County Surgical Suites, they can have total joint replacement surgery, be home the same day, and never go to the hospital at all.
At this point, how many outpatient total joint replacements have BCOS surgeons done?
We do approximately 15 same-day total joint replacement surgeries per week. At this point, we’ve done well over 1600 of these surgeries, about half at Doylestown Hospital and half at BCSS. Since it opened in 2019, I’m sure BCSS has become the busiest ambulatory surgery center in the state of Pennsylvania for outpatient total joint replacements.
Have you seen a steady increase in outpatient total joint replacements since launching the program in 2017?
Absolutely. It had been predicted that orthopedic surgeons across the country would be doing 50% of our total joint replacements in the outpatient setting by 2026. I think we’ve already met that goal in 2021. We are way ahead of schedule.
Do you believe the COVID-19 pandemic has accelerated the growth of same-day total joint replacement surgeries?
Most definitely. Even patients who may have preferred a short hospital stay a few years ago, now prefer to go back to their home as soon as possible and have a visiting nurse. In fact, I had an 82-year-old patient a few years ago who had an outpatient total hip replacement that went very well.
Why do you believe programs such as Heal@Home are so important in this COVID era, more than ever?
During this pandemic, hospitals are trying to maintain availability to treat sick patients, and some hospitals have even shut down elective surgeries at times. But patients who are suffering from bone-on-bone arthritis are in severe pain and in some older folks, arthritis can come on pretty rapidly and they can start falling, which leads to other problems. In this landscape, the Heal@Home program, particularly at Bucks County Surgical Suites, allows us to perform a total joint replacement in a way that provides relief for them and doesn’t burden the resources of the hospital system. This has been very beneficial from a societal perspective during this precarious time.
From the patient perspective, can you explain what to expect from outpatient total joint replacement surgery?
Patients should expect to have a thorough pre-surgery medical evaluation and preparation program. Then on the day of surgery they arrive, get changed for the surgery, and talk through the anesthesia plan with the anesthesiologist. For surgery, the patient is sedated with anesthesia similar to what you would get for a colonoscopy. The patient is not put on a breathing machine, which greatly reduces many risks that people associate with anesthesia. Then the surgery itself takes about 45 minutes.
What happens after surgery for outpatient total joint replacement?
After surgery, the patient goes to the recovery room and is monitored while the anesthetic wears off. Then they are basically up and starting to walk right away. We start with a walker and teach the patients how to use that safely. In order to be released to go home, the patient must be able to walk 100 feet, be able to urinate, and have pain that is well-controlled. Believe it or not, every patient at the surgery center has successfully been able to go home the same day as their surgery.
What happens once the patient gets home after same-day joint replacement surgery? Is there a visiting nurse or physical therapy?
Yes, that’s one of the most important things about our protocol for same-day joint replacement surgery. The patient is met by the physical therapist and the visiting nurse at home to help them get safely into the house. They do some physical therapy at home, check their vital signs, and make sure they are comfortable navigating the home environment. It’s also important that every patient has a friend or family member stay with them at home the first night.
The physical therapist and nurse return to do additional therapy the next two days. In most cases, the patient is able to go to outpatient physical therapy after the third day.
Do patients have contact with the doctor once they are home from outpatient joint replacement surgery?
We typically contact the patient the night of surgery to check on how they’re doing. The visiting nurse will also reach out to us if they have a concern or want clarification on something. Patients can also call our office, even after hours. Our practice is not like some of the big city practices where you go to a call center with 80 people answering the phone. At BCOS, one of our doctors is on call and accessible every night.
What have you learned in the years since the Heal@Home program began?
Barring medical issues that preclude outpatient surgery. I’ve learned that the majority of people have better outcomes with same-day surgery. You may wonder…how can that be? But the mobility that comes with being in your own home is really beneficial to the overall success short-term and long-term.
How have people found out about BCOS’s outpatient total joint replacement program?
Besides word of mouth, positive Google reviews have actually driven a great deal of patients toward our practice and the Heal@Home program. It has turned out to be one of the most valuable resources for patients who are curious or anxious about having total joint replacement as an outpatient procedure. Being able to read those honest, frank reviews, that are written by actual patients, and see that across the board patients are very happy with the same-day joint replacement has been gratifying for us and reassuring to our new patients.
For more information on Bucks County Orthopedic Specialists and the outpatient total joint replacement program, known as Heal@Home, reach out to our office at 215-348-7000.
About Bucks County Orthopedic Specialists
Bucks County Orthopedic Specialists (BCOS) is the largest orthopedic practice in the community, serving the Bucks and Montgomery County region for over 40 years. The multi-specialty practice has fellowship-trained physicians from leading university hospitals, achieving exceptional results using state-of-the-art, minimally invasive treatments with a commitment from the total team to provide seamless, personalized care from start to finish. BCOS surgeons perform thousands of surgeries each year and have offices in Doylestown and Warrington, with an office in Newtown opening soon. To learn more visit: www.bucksortho.com.
