A recipe for successful same-day hip and knee replacements

Needing a surgical procedure in the midst of the COVID-19 pandemic may seem daunting for many, so options where patients do not require a hospital stay are optimal. A Baylor College of Medicine orthopedic surgeon explains how he is able to perform same-day hip and knee replacements and why most of his patients do not require strong pain medications, such as opioids, during recovery.

“There is a recipe for success to go home on the same day of the surgery while still maintaining the same recovery criteria as those who require overnight hospitalization or longer. What I do is facilitate patients achieving those milestones a lot quicker,” said Dr. Mohamad Halawi, faculty in the Joseph Barnhart Department of Orthopedic Surgery at Baylor.

According to Halawi, who also serves as chief quality officer for musculoskeletal services at Baylor St. Luke’s Medical Center, that recipe for success starts with establishing a good relationship with patients, preparing them for surgery, providing clear expectations of the recovery process and trying to anticipate and mitigate any potential obstacles early on.

“It is important to resist the tunnel vision where one looks only at the hip or the knee. Rather, I am interested in the whole patient. What is their social support system like? What medical problems do they have? We want the best possible outcomes for patients and the optimization process starts from day one.”

It’s important to address any active medical issues so that once the patient has the surgery, their hip and knee has their undivided attention, Halawi said.

Because Halawi educates his patients about exercises and has them start on these exercises ahead of surgery, patients rarely need to seek physical therapy after their joint replacement. This means one less outing during the COVID-19 pandemic.

Halawi also involves a patient’s caregiver to ensure that the patient has the support and reassurance they will need for a successful recovery.

“While most patients are able to independently care for themselves, teaming up with caregivers can help further improve their recovery,” he said.

One of the biggest anxieties that patients tend to have is about pain. However, Halawi has found that the vast majority of his patients do not require opioids to manage their postsurgical pain. In general, Halawi said that most patients are able to manage pain using over-the-counter pain medications.

Halawi, who is an avid scientist and the director of the Department of Orthopedic Surgery Outcomes Center at Baylor, emphasizes that this is possible thanks to a number of perioperative advancements. These include minimally invasive surgery, better anesthesia techniques, and safer analgesia protocols that target the pain pathway at many levels and even pre-empts it before the surgery,

“It is a powerful experience when a patient wakes up after surgery not having any pain. We are now able to stand ahead of the pain and avoid having to catch up like we used to do in the past,” he said.

Last but not least, being easily available to address patient questions or concerns following procedures is another very important ingredient for successful same-day surgery.

“What used to take us days to achieve, now we can achieve in literally an hour or two after patients wake up from anesthesia,” Halawi said. “When you talk about a situation like the COVID-19 pandemic, where patients may be anxious and understandably so, providing the option to recover safely and effectively from the comfort of one’s home is important as delaying surgery will only prolong pain and reduced function.”

Halawi emphasizes that there is no cookie cutter approach for all patients. It’s important to take a personalized approach and understand where each patient is coming from, tackle their concerns and offer a more tailored procedure that meets their individual needs. This leads to a more expected and smoother recovery following surgery.