Q. Why are Americans outliving their joints?
A. Our knee, hip and ankle joints are weight-bearing, so while the cartilage of other joints also wears out, the degeneration of these joints is painful due to their load-bearing nature. From 2000 to 2010, the rate of joint replacement surgeries (mainly hip and knee) nearly doubled in the U.S. One factor driving the increase is a cultural change: Today, people in their golden years expect to remain active – to travel, to play vigorous sports. Also, thanks to the excellent results of knee and hip replacement procedures, more primary care physicians and orthopedic surgeons are recommending them.
Q. I’m hearing about people going directly home to heal after joint replacement surgery. Is this a trend?
A. A big one. It’s an approach we at Northern Westchester Hospital (NWH) have long espoused, now gaining much larger national attention. Studies show that after knee or hip replacement surgery, there’s literally no place like home for healing—that it’s usually safer and more beneficial to the patient. At NWH, we’re now finding that patients who live alone can also safely heal at home. At home, you’re forced to do more sooner, which speeds up the joint’s return to normal function. And the environment is typically cleaner and more comforting.
Q. So people want to heal at home?
A. Almost all patients consider home ideal. People would rather be in a safe, familiar environment where they can heal with careful guidance and instruction from clinical providers. It’s not for everyone, but it’s for more and more patients.
Q. Have certain medical advances made healing at home possible?
A. Yes! Major advancements in surgical technique, such as the anterior approach to hip replacement that leaves tendons intact, and customized total knee replacement surgery, greatly facilitate discharging patients to home. All my total hip and knee replacement patients walk the very day of surgery and are typically sent home within 24-48 hours, with some going home the day of surgery. Also, our better understanding of post-op pain management and physical therapy has significantly smoothed the transition to healing. At NWH, we use a program called ERAS (Enhanced Recovery After Surgery) which integrates anesthesia, physical therapy and orthopedic care teams to better manage patients recovery while in the hospital.
Q. What actually happens at home?
A. As an NWH patient, you must pass mobility and independence benchmarks before going directly home.We wouldn’t use this approach, with, for example, an elderly person with balance issues. Once you’re home, there are now many more services available to support healing, including online-based physical therapy. Reflecting NWH’s patient-centered approach, my office is very attentive to our patients’ home-recovery needs. My nurse and I text with at-home patients, providing real-time contact and reassurance. My patients tell me, “I’m so happy I could be home with my family! It pushed me to be more active more quickly.” I’m confident this is the best path for most people. If it were me, I’d choose it.
Eric Grossman, MD, FAAOS, Director of Total Joint Arthroplasty at The Rothman Orthopaedic Institute – New York. Dr. Grossman has published research in the field of total joint arthroplasty, and performed approximately 5000 total joint replacements.
