At Olympia Orthopaedic Associates, our cutting-edge physicians are recognized leaders in outpatient total joint replacement.
Historically, joint replacement surgery has been performed on an inpatient basis in a hospital setting. But now, new surgical techniques and advanced training allows our team to perform these surgeries on an outpatient basis at our ambulatory surgery center.
We are the only orthopaedic practice in the area offering this revolutionary Outpatient Total Joint Replacement Program and we were among the first 5% in the nation to offer outpatient joint replacements. The best part? You get to sleep in your bed the night of your surgery!
If you’re suffering from any of the following symptoms, you may be a candidate for outpatient joint replacement surgery:
- Severe joint pain that may keep you awake at night
- Joint pain that prevents you from resting or being activity
- Joint pain that disrupts necessary and daily functions (eg. walking or climbing stairs)
Joint Replacement Specialist, Dr. Brodie Wood discusses the process before and after an Outpatient Joint Replacement at Olympia Orthopaedic Associates. He also discusses common questions about life after a Joint Replacement procedure.
Dr. Brodie Wood
Outpatient Joint Replacement Surgeon
Types of Joint Replacement Surgery
Joint Replacement surgery is used to treat osteoarthritis that reaches severe stages or does not respond to nonsurgical treatment options. Our team offers same-day total hip, knee, and shoulder replacement surgery at the Olympia Surgery Center.
Partial & Total Knee Replacement
During the procedure, the surgeon carefully removes osteoarthritic bone and damaged cartilage in the knee joint and replaces it with special components, including metal caps that are placed where the osteoarthritic bone has been removed from the femur and tibia (the bones that make up the knee joint). Then a medical-grade polyethylene plastic spacer is placed between the bones of the knee. Together with the metal cap, the spacer recreates the normal function of a healthy knee joint. In the final stage of these procedures, advanced imaging and flexibility tests are used to ensure proper placement of the implants. Both procedures take about two hours from start to finish.
Partial Knee Replacement: In some cases, only one side or compartment of the knee is damaged due to osteoarthritis. In this case, only the damaged portions of the bone are removed and the healthy bone is left intact.
Total Knee Replacement: In other cases, both compartments of the knee are damaged due to osteoarthritis, requiring both sides to be repaired.
“Your decision to proceed with a knee replacement is based on your underlying diagnosis and how that arthritic knee is affecting your life. At the point where you get a decreased lifestyle, increased pain, decreased ability to get through your daily activities, and you have failed conservative measures, we would have a discussion regarding a knee replacement. I think it’s important to know that a lot of patients feel that knee replacement is kind of the end of the road or it’s kind of a last resort, but it is the core operative thing that we can do to give you that active lifestyle back. The days before, when you wanted to wait as long as possible and it was a week in the hospital and it was time in a nursing home— those days are gone. Knee replacement is cutting-edge and it’s exciting.”
Dr. L. Anthony Agtarap
Knee Replacement Specialist
The goal of a hip replacement surgery is to repair both the ball and the socket of the hip. There can be several approaches used: a posterior approach, a direct lateral approach, or a direct anterior approach. You and your surgeon will discuss which option is best for your circumstances.
During all types of hip replacement surgery, the surgeon carefully removes osteoarthritic bone and damaged cartilage in the hip joint and replaces it with special components. First, the damaged femoral head (the ball of the hip joint) is replaced with a metal or ceramic implant. Next, damaged bone and cartilage in the socket portion of the hip is removed and replaced with a new implant. Then a medical grade polyethylene plastic spacer is placed between the ball and the socket so that they can glide smoothly over one another as they do in a healthy hip joint. In the final stage of these procedures, advanced imaging and flexibility tests are used to ensure proper placement of the implants. Hip replacement procedures take about two hours from start to finish.
Total shoulder replacement surgery involves removing damaged areas and replacing them with artificial parts. The goal of the procedure is performed to relieve pain and restore mobility. A shoulder replacement may be required due to severe arthritis or a fracture in your shoulder joint.
During the procedure, an incision is made on the front of the shoulder. Modern surgical techniques and new total shoulder components allow surgeons to make much smaller incisions. Then any osteoarthritic bone is removed and prepared for implants before metal and plastic implants are perfectly positioned and then cemented in place. The incision is then carefully closed and sterilely dressed.
After all procedures, patients are brought to a recovery room where they can recover in comfort. Nurses and medical staff will then review post-operative instructions, begin physical therapy, and ensure you have all follow-up therapy in place.
In a traditional total joint replacement surgery, the patient stays in the hospital for several days before going home. However, in an outpatient total joint replacement, the patient is able to go home just hours after surgery.
“Patients are embracing this program,” says Sylvia Johns, V.P. of Surgical Services. “They love the idea of being able to go home and avoiding a hospital stay. Just knowing that they’ll be able to recover in the comfort of their own home is very appealing. For eligible patients, outpatient joint replacement offers a less expensive alternative with proven-positive patient outcomes.
Advantages of outpatient total joint replacements:
- Expedite your recovery
- Go home the day of your procedure
- Recover in your own home
- Schedule on your terms
- Save money
- Reduce the risk of infection
“Our infection rates are extremely low compared to a hospital setting,” reports Sylvia. “In general, ambulatory surgery centers have a lower infection rate than hospitals for superbugs like MRSA and VRE. Most patients in our setting are healthier than patients seen at the hospital. Our patients are motivated to do well after outpatient surgery. With the ability to discharge home the same day, our patients tend to recover faster than those who are admitted to the hospital or to a skilled nursing facility.”
“When I’m talking to a patient regarding the possibility of performing an outpatient joint replacement, I think it’s important to share with them some of the advantages of that procedure, I think the biggest advantage is probably cost. I think to perform it as an outpatient with less resources and less length-of-stay is a cost savings to the healthcare environment. Number two, there is something wonderful about being out of the hospital. The hospital is traditionally a place for sick patients and there are many patients there with active disease. Our outpatients tolerate the recovery, get home, and sleep in their own bed that night.”
Dr. L. Anthony Agtarap
Joint Replacement Specialist
Our Nursing Program
The day-to-day management of the program is done by Becki Taylor, RN, BSN who has helped kickstart this wonderful service from the beginning.
“I was hired here about five years ago when they started their outpatient total joint program,” says Becki. “My role initially was to help start up the program. Now, my role is to screen patients and make sure that they have all necessary resources before and after their surgery. One of the ways I do this is by teaching an education class once a week that reviews the ins and outs of what to expect for their procedure.”
Speaking of her colleague, Sylvia says: “Becki acts like a concierge for our patients. She’s their person—if they have any questions, they can call her on a direct line and she acts as the liaison. Becki has been the glue to our program.”
The program nurse is available for all patients of the Ambulatory Surgery Center, whether they have a question about their medication, their bandage, their physical therapy plan, or anything else.
Our Total Joint Replacement Class
There are many appointments involved in the ramp-up to a total joint replacement. So our patients sometimes wonder why we add a mandatory Total Joint Replacement Class to their pre-surgery to-do list. But patients always seem to have the same reaction afterwards: “That was so helpful! I feel so much better and prepared!” Olympia Orthopaedic Associates even took accessibility a step further and created an online video class that covers a good chunk of the in-person course.
“I do get feedback quite often that the class was really helpful,” says Becki. “Or patients will say that they feel a lot better afterwards because their questions were answered.”
The class is held on Thursdays and lasts approximately an hour. Patients also receive an education booklet to take home to review at their leisure. The class answer questions such as:
- What equipment do I need post-surgery?
- What should I expect the day of surgery?
- What are the risks and benefits of this surgery?
- How do I use sequential compression sleeves?
- How will I control my pain post-operatively?
DYK? Sequential compression sleeves help prevent blood clots. They are devices worn around the lower extremities to help prevent blood clots. They should be worn when you’re most at rest. They should be worn for about two weeks in the postoperative period. Things like simple ankle pumps can help keep your blood circulating. They are discussed at-length in the Total Joint Replacement Class.
Planning for Pain Control
It’s completely normal to be concerned about pain after surgery. In fact, it’s one of the most anxiety-inducing parts of surgery for many of our patients. That’s why our team takes postoperative pain management seriously and has good solutions ready for you. Better yet, we’ll discuss them thoroughly at your pre-op appointments and during the Total Joint Replacement Class.
“Our anesthesiologists are very good about calming the patient and then also explaining the different pain control methods that they’ll utilize during their stay with us,” says Becki. “Postoperatively our nursing staff does very thorough education about when to start oral pain medication, and then other modalities that could help relieve patient pain over the counter medications, ice therapy, and things like that.”
Knee replacement: Patients are offered a nerve block. This gives them a period of time where they’re comfortable and able to easily adjust to being at home and taking oral pain medication.
Hip replacement: Patients are given a multimodal pain cocktail intraoperatively that is injected into the surrounding tissues of the hip to help with postoperative pain and ease the transition to oral pain medication.
Shoulder replacements: Patients are offered an interscalene nerve block, which helps patients through the first first day or two of acute pain and then they can easily transition to oral pain medication.
Joint replacement is a major surgery and although advances in technology, medical care, and screening have made the procedure very safe and effective, there are still potential risks. That’s why all patients are carefully screened to determine if they can safely have outpatient surgery done at Olympia Surgery Center or need to be scheduled at a local hospital instead.
What to Expect
After you and your doctor decide to proceed with a total joint replacement, we will arrange for you to have lab work and an EKG (heart rhythm test), as well as a nasal MRSA swab. Based on your results, your provider will have a better idea if you are eligible for surgery at our Ambulatory Surgery Centre, or if you need further workup for safety’s sake. You will also do a telephone screening with the surgery scheduler as well.
“When I do a surgical screening for a patient,” says Becki, “And there is anything that seems a little abnormal or is questionable regarding the patient’s comorbidities, then I take it back to our anesthesia providers. And then they guide me on if I need to have the patient have a further workup or if they’re cleared to proceed.”
Following that, patients are scheduled for what’s called a pre-habilitation or pre-operative physical therapy evaluation. During that appointment, a physical therapist reviews any equipment needs and discusses home setup. They’ll also do baseline measurements to ascertain pre-operative range of motion.
Considerations for Surgery
- Caregiver: We require three to five days of somebody being there around-the-clock to help care for the patient. We don’t do any home health services, so there must be a responsible adult with the patient.
- Mobility: The patient has to be mobile and able to walk on their own under normal circumstances.
- General health: Outpatient surgery candidates cannot have any serious chronic medical condition such as unstable heart problems, unstable respiratory issues or advanced disease issues.
- Weight: A patient’s BMI must be less than 40.
- Blood sugar control: Diabetic patients must have an A1c of less than 8.
Day of Surgery
Typically, patients undergoing joint replacement at Olympia Surgery Center will be with us for approximately eight hours. There is time set aside to get the patient ready for surgery, then each surgery takes approximately two hours, followed by a recovery period of four to five hours.
“Patients are busy for the most part throughout the day,” says Becki. “There’s not really a lot of downtime to watch TV or anything like that. Our goal is to get you back to your home as efficiently as possible.”
What should I bring?
A typical surgery day list includes:
- Loose, comfortable clothing
- A front-wheeled walker (for hip or knee surgeries)
- Home medications
- A set of sequential compression sleeves
When will I start physical therapy?
We have one dedicated physical therapist that works in our surgery center. That therapist is on-site for as long as patients are on-site. This is different from a hospital setting, where if a patient comes out of surgery a little later during the day, they might not have the opportunity to work with a physical therapist the same day.
“I think that’s where we stand out a little bit. We have this dedicated therapist who is completely available to these patients,” says Becki. “If they’re not ready to get up right away, she comes back and checks on them. If they need maybe a second time to get up, then that’s an option too.”
Our program is more a well-oiled machine in terms of timing. There is someone scheduled in our department to be here when the patients are ready to get up and move. According to Becki: “Having a physical therapist on-site to specifically work with our surgery patients is tremendously rewarding for our patients and has helped us be successful with our program.”
Patient care doesn’t stop after surgery. In fact, it’s just beginning! Our surgical center staff follows up with all of our patients the day after surgery. “And then I give every patient my email, my direct line that they can reach out to me for concerns,” says Becki. “I usually follow up with patients at about a week just to make sure that everything is going smoothly. And then they have their postoperative appointment with their provider 10 to 14 days after their surgery.”
“Patients get to go home and they’re recovering while they have the same support, if not more, than they would at the hospitals,” says Sylvia.
Ongoing Physical Therapy
All outpatients need to start outpatient physical therapy within five days of their procedure. It is essential to commit yourself to the prescribed physical therapy program prescribed so that you can recover quickly and get the most out of this procedure. After therapy is completed, you can look forward to getting back into fitness and hobbies you once enjoyed.
“We ask that patients start physical therapy earlier rather than later,” states Becki. “One of the reasons for that is so that healthcare professionals can note anything that’s concerning and report it to the surgeon’s team.”
Physical therapy after surgery usually happens twice a week for about four weeks, although each patient’s plan will be slightly different. It can be upwards of six weeks for some knee replacement patients. All along the way, you will have contact with our medical professional, who can assess your progress and help with any recovery speedbumps.
Rapid Orthopaedic Care
As part of Olympia Orthopaedic Associates, we have our Rapid Orthopaedic Centre (ROC) open seven days a week from 10 AM to 7 PM.
“The ROC is a great option for postoperative management if an issue comes up during the evening or on a weekend,” says Matthew Marshall, ROCC Physician’s Assistant. “If one of our OOA surgeons has done a surgery and the patient is really concerned that they may have an infection or a blood clot or something wrong with their incision they can see us after-hours or on a weekend. We can reassure them and we can take care of the problem. If it’s something serious, we can get a hold of the surgeon right then.”
The physician’s assistants at the ROC have access to our patients’ Operating Room notes. They are also able to order antibiotics, imaging, and perform minor procedures.
“A lot of times,” says Matthew, “Emergency Rooms don’t see total post-operative knee joint replacements or spine surgeries and don’t know what “normal” looks like post-operatively. So sometimes there’s an over work-up or potentially even an under work-up when patients go to an Emergency Room with their concern.”
We constantly have repeat patients come through our Olympia Surgery Center. When patients have a good experience with one joint replacement, they are confident about any other joint replacement surgeries they need to schedule with us. It’s reassuring for our team to see so many repeat patients because it means our staff is looking after people well and providing a great surgical experience.
“Our patient satisfaction rate overall is really high for our surgery center,” reports Sylvia. “Patients feel taken care of. They feel heard. They often name specific nurses that have worked with them, whether it’s Becki, or someone in pre-op, the PACU, or in the recovery area.”
“I feel like our staff is just very close knit,” says Becki. “We work really, really well together and our patient flow reflects that. We really work hard for efficiency.”
If you have been suffering from osteoarthritis of the hip or knee and are ready to discuss Joint Replacement Procedures – Olympia Orthopaedic Associates has your solution. Contact us to speak about a Joint Replacement Procedure and learn about all of the options available to you. We’re here to help!
Should I Make An Appointment?
Call Us Today! 360.570.3460