Dr. Craig McAllister and EvergreenHealth are the first on West Coast to Offer Outpatient Hip and Knee Replacement Surgery
Thanks to advances in minimally invasive surgery, pain management, preoperative preparation and rapid rehabilitation methods, patients of Dr. Craig McAllister at EvergreenHealth in Kirkland, Washington, can now receive outpatient hip and knee replacement surgery. Dr. McAllister and EvergreenHealth were the first physician and hospital team on the West Coast to offer outpatient hip and knee replacement surgery.
Dr. McAllister and his team perform nearly 400 primary hip or knee replacement surgeries annually. Since December 2013, more than 50 percent of his patients have been outpatients, a rate that leads national trends and surpasses the 10-year forecast nationwide, according to Dr. McAllister.
“Patients are happier, and tend to recover better at home,” said Dr. McAllister. “And as outpatients, the overall cost of care is lower.”
With the outpatient procedure, patients can be in and out of surgery and back home in the same day. The average hospital stay for traditional hip and knee replacement patients is two to three days, and many patients require extended stays in skilled nursing facilities.
For Helen Zielke of Bothell, Washington, the outpatient surgery meant less pain and swelling, greater flexibility in her knee, and the freedom to go home as soon as she wanted.
Zielke had her right knee replaced through outpatient surgery at EvergreenHealth in May 2014, a little less than a year after having her left knee replaced through conventional surgery. This time, she was able to return home, where her husband cared for her in the first four days following surgery, as soon as she was ready.
“The difference between this outpatient knee replacement and my previous inpatient experience is extraordinary,” Zielke said. “I had very minimum swelling and so much more flexibility after the outpatient procedure.”
What most surprised her, Zielke said, is that she did not experience any pain in recovery. “I had a hard time believing that I had the surgery until they showed me the bandage.”
Outpatient hip and knee replacement is made possible by a combination of patient selection and education, multimodal pain management and minimally invasive surgical techniques.
According to Dr. McAllister, most hip and knee replacement patients fall in to one of two categories. The first includes elderly patients with existing medical conditions, who may not have the resources at home or who may have other mitigating circumstances that make it more difficult for them to return home immediately after surgery. While these patients may need to stay in the hospital, they can still benefit from the minimally invasive surgical techniques and decreased need for narcotics.
The second group includes more active patients without other medical conditions and with a good home support system.
”Each patient is evaluated on a set of criteria to determine their candidacy for the procedure, including age, existing medical conditions, medications and physical activity, Dr. McAllister explained.
Patients who qualify for the outpatient surgery – typically healthier, more physically active individuals -- go through an intensive pre-operation informational program with Dr. McAllister. The program includes one-on-one patient specific education for the patient and their family members to prepare them for an optimal surgery and healing experience.
While this approach requires more time prior to surgery, it eliminates many of the time-intensive issues that can come up after surgery, Dr. McAllister explained.
Multimodal Pain Management
Outpatient knee and hip surgery is also made possible by multimodal pain management. Pain management begins in the operating room with general anesthesia so that the patient wakes up easily. Preemptive analgesics – medication administered to the patient prior to surgery – are also used to minimize discomfort after the procedure.
“The numbing medicines last up to 72 hours, so our patients are comfortable right from the beginning,” said Dr. McAllister.
Pain management continues at home with the use of non-narcotic pain medications, cold therapy and a continuous passive motion machine that gradually moves the joint through a prescribed arc of motion for an extended period of time.
Minimally Invasive Techniques
Finally, outpatient knee and hip surgery is made possible with minimally invasive surgical techniques.
“We have a dedicated surgery team at EvergreenHealth that is very skilled and experienced with these precise, minimally invasive techniques,” Dr. McAllister said.
Future of Joint Replacement
In May, Dr. McAllister chaired an annual May Meeting of orthopedists in Kirkland, Washington. Joint replacement specialists from across the country attended the roundtable discussion of the future of joint replacement.
“The level of interest at this year’s roundtable discussion was incredible,” Dr. McAllister said. “Specialists from all over the country came specifically to discuss outpatient hip and knee replacement.”
One highlight of the conference was the video appearance of outpatient hip replacement patient and orthopedic surgeon Dr. Robert Hunter of Salida, Colorado. In the video, Hunter was shown walking just hours after his hip replacement – then he surprised attendees by joining the meeting online from his car where he was driving himself, just weeks after his surgery.
In fact, Dr. Hunter said, he was able to drive within days of his surgery. While he expected some pain and restricted mobility post-surgery, Dr. Hunter said, “In actuality, I had essentially no pain. I walked on my own from the operating room to my hotel room after the procedure.”
“I never used crutches,” Dr. Hunter went on to say. “I turned over a pitching wedge and used it as a cane for a couple of days, and that was about it.”
Dr. Hunter was back at work within nine days. “I had the surgery done on a Monday and I operated the following Friday.”
Asked if he would again choose outpatient surgery for another joint replacement, Dr. Hunter said, “I’m going to insist on it. I wouldn’t do it any other way.”