Outpatient Hip Replacement Surgery—What Does the Procedure Look Like?
This post was co-authored by Grace McClure and Dr. Nicholas Frisch), M.D., OS, MBA.
Outpatient hip replacement surgery is on the rise across the country. But what exactly does outpatient hip replacement surgery entail? What's the difference between same-day hip replacement surgery versus a traditional, hospital replacement? Read on as we answer these questions (and more) so that you can determine if an outpatient hip replacement is right for you.
An outpatient hip replacement is also called a "same-day hip replacement". During a same-day hip replacement, the whole procedure (admittance, surgery, discharge) happens in less than 24 hours. An outpatient replacement usually takes place in a local surgery center (also called an ambulatory surgery center) or in a special hospital wing. Outpatient hip replacement surgery is not recommended for every patient, but is increasingly becoming the preference of more surgeons and patients.
Read the "5 Key Factors for Outpatient Success" to determine if you're someone who fits the bill for same-day surgery!
What Are the Benefits of Outpatient Hip Replacement (THR)?
The Latest and Greatest: With most outpatient centers being relatively new, they tend to be more technologically advanced with new equipment and surgeons who practice the latest techniques. Generally, this means a focus on minimally invasive surgery and robotic-arm assisted surgery.
Stronger Emphasis on Patient Prep and Pre-Op Health: With same-day surgery, there is a greater emphasis on patients being healthier and more prepared for surgery. Better pre-op health and patient preparedness is proven to lower surgery day risk and improve procedure outcomes. Outpatient surgery centers tend to invest more in PreHab so that patients are able to recover safely and successfully at home.
Lower rates of infection: Longer stays in the hospital will increase your risk for hospital infections. By avoiding an overnight stay or spending less than 24 hours in a facility, infection risk will drop.
Recover At Home: Although this is sometimes what patients are afraid of, a same-day procedure means you will recover at-home. This means recovering in the comfort of your own home, with less support from your professional care team. Some people prefer this independence and like to have greater control over their recovery with their own support system, outside of the hospital or rehab setting.
Dr. Frisch explains, "For the right patients, going home the same day of surgery can provide an incredibly positive experience. The ability to safely recover almost immediately in the comfort of your own home can improve your overall satisfaction."
What is Outpatient Hip Replacement?
An outpatient hip replacement and a hip replacement in a hospital are very similar. The procedure itself will be nearly identical to a traditional hip replacement. The differences in outpatient surgery are mostly noticeable in the amount of pre-op preparation required, the types of patients who have an outpatient replacement, the time spent under your surgeon's care, and where you spend most of your recovery.
In a total hip replacement (outpatient or inpatient) the cartilage and bone that have been damaged are removed. To simplify, once the damaged joint is removed, the healthy joint is resurfaced and the different parts of your implant/prosthesis are secured into place.
The end result of hip replacement surgery is a healthy joint that is fit with artificial components that will offer you greater mobility, less pain, and new lease on life!
How Long Will My Outpatient Hip Replacement Take?
The average hip replacement surgery takes just 1-2 hours to perform. The length of your hip operation depends on factors like: your body weight, how bad your joint osteoarthritis is, the type of replacement you're receiving (e.g. anterior vs. posterior) and if you're getting a partial or full replacement.
The entire same-day joint replacement episode will have you in and out in less than 24 hours (unless your care team wants you to stay overnight for monitoring). With the operation itself lasting under 2 hours, the rest of the time is spent being "checked-in", recovering/ waking up from the procedure, and meeting with various members of your care team (like a physical therapist) who will ensure you're ready to go home.
Step-by-Step Guide to a Same-Day Hip Replacement
1. Weeks Before Surgery
On surgery day, you should feel mentally, physically, and environmentally ready. If you're having a same-day replacement, your care team will have likely emphasised pre-op preparedness. For many patients, this means working through a daily PreHab program in the weeks that lead up to surgery day to improve your health and readiness. PeerWell's outpatient PreHab program for hip replacement surgery delivers a daily checklist of tasks to your smartphone. The aim of PeerWell's PreHab program is to lower your pre-op risk and speed-up your recovery by getting into your best health prior to surgery day.
PeerWell's ReHab for Same-Day Joint Surgery Will Help You:
Feel supported and proactive in your recovery with straightforward daily tasks to complete
Recovery faster, better and safer.
Rebuild strength, motion, flexion, and extension in the muscles surrounding your joint
Regain normal movement in your joint
Better deal with pain
Monitor and avoid post-op complications
Track and measure your improvement (e.g. with the in-app hip flexion measurement tool)
2. Arrive at Surgery Center/ Check-in
Fast forward to surgery day, where you will be checked-in at your ambulatory center or hospital. This will involve some light paperwork. After check-in, you will be escorted to your room where you will change into your hospital gown and meet with your surgeon. In the operating room, you will likely be given either: general anesthetic (being put to sleep), spinal anesthetic, or a combination of the two. Read about the differences in anesthesia and the pros and cons to each here.
Once you are feeling the affects of your choice anesthesia, the procedure (lasting 1-2 hours) will begin.
3. Surgery Time
Depending on the type of hip replacement you are getting, the exact procedure will differ slightly. However, here is a high-level look at what your actual hip replacement surgery will look like.
Once everything is sterilized and in place, your surgeon will make the incision. If you're having minimally invasive surgery this cut will be 3-5 inches long. In a traditional replacement (which is less common in an outpatient setting) the incision may be 8-10 inches long. The incision will reveal the top of your thighbone, allowing your surgeon to gain access to your hip bone.
B. Resurface, Remove, Replace
Your hip bone will be dislocated by pulling the ball (femur head) out of the socket. Next, the socket is resurfaced, removing the diseased and damaged bone. An artificial cup is fit into the hollow (socket). This component is press-fit into place. The plastic "bowl" insert is fastened into the cup, forming a new artificial socket. This new socket is called the "acetabular component".
Once the ball-shaped head of the femur is removed, your surgeon will prepare the inside of your thigh bone (femur). Once your thigh bone is ready, the artificial femur component will be put into place. Next, a femoral head (also called a ball) will be selected. There are many femoral head sizes and shapes, so your surgeon will test which fits best into your new acetabular component). These two pieces (acetabular and femoral component) make-up the new hip joint.
C. Test Fit and Movement
Finally, your surgeon will test the fit and movement of your new joint. This will mean stretching your surgical leg (forward, backward, lifting it up and down) and possibly x-raying the new joint. Once your surgeon is confident in your movement and that you are not at risk for dislocation, the wound will be closed with staples or stitches.
3. Recover and Discharge Home!
After your surgery, you will be moved into the recovery room until anesthesia has worn off. You will be visited by your care team (doctor, nurses, physical therapist, social worker etc.) who will sign-off that you're ready to go home. Usually, this means showing that you can walk up and down stairs, get on and off the toilet, resume basic movements, and that your pain is under control.
Once you've passed the test, you will be free to leave the facility. Of course, you won't be able to drive and will need the support of your "coach" or at-home support system to assist you in the coming days and hours. It's important to keep-up with an at-home rehabilitation (ReHab) program. A solid program should give you daily tasks to complete each day in addition to your in-person physical therapy.
Dr. Frisch sums it up by saying that "After your total hip replacement, you will be able to start walking immediately. It will feel different and right after surgery you will have surgical pain, but as you begin to start doing your normal activities you will notice improvement, both physically and mentally. By going home the same day patients tend to fall into their routines faster and feel more confident in their new joint."
Get matched to a top orthopedic surgeon for an inpatient or outpatient replacement. We will match you with a surgeon in your area who offers PeerWell's PreHab & ReHab program for free! With PreHab (followed by ReHab) you will recover faster, better and safer from your replacement.
Dr. Nicholas Frisch, M.D., OS, MBA is an award-winning orthopedic surgeon based out of Rochester, Michigan. He focuses on minimally invasive joint replacement surgery and complex revisions. Dr. Frisch completed his residency at Henry Ford Hospital in Detroit and his Adult Reconstruction Fellowship at Rush University Medical Center in Chicago. Dr. Frisch is has won Orthopedics Best Clinical Article Award, the AAHKS Healthcare Policy Fellowship, Outstanding Resident Award Henry Ford Hospital, the Ford Motor Co. Connected Health Challenge, and more.