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Same-Day Joint Replacement

Building contractor Paul Roche gets knee surgery and is back on the job

8/12/2020

Building contractor Paul Roche is on his feet most of the day as he remodels homes, renovates kitchens, and works on exteriors. He is also on his knees, laying out floors and performing other tasks of the construction trade. Eventually, his active lifestyle took a toll on his knees and he experienced significant arthritis that caused excruciating daily pain and limited his mobility.

“I couldn’t even walk up and down stairs,” he says. “I was holding both railings, like an 80-year-old man.”

Time to Act

He knew it was time to consider his options for relief, which in his case turned out to be a left knee replacement.

“I couldn’t put it off any longer,” Paul says.

So, he visited Emerson Orthopedics in Littleton. In the past, knee replacement surgery may have meant a lengthy hospital stay to recover. Because of advances in pain management, some patients can go home the same day. When appropriate, outpatient surgery can reduce costs, reduce stress, and speed up the recovery process. It also reduces the time lost from work and family life.

“Paul came into the office and we started discussing knee replacement surgery,” says Brittany Boisvert, MD, an orthopedic surgeon with Emerson Orthopedic Associates. “He is on the younger side; he is otherwise very healthy, very active, and very motivated. These factors made him a strong candidate for same-day surgery.”

Successful Surgery

Paul’s procedure was a great success. “The operation was smooth,” he says. “I went to Emerson for surgery in the morning and I was home that night.”

Dr. Boisvert says, “We have changed how we manage pain. When possible, we try to eliminate or minimize the use of opioids. When patients wake, they have had less narcotic and pain medication, so they are not as groggy or nauseous. We use a long-acting injectable local anesthetic at the time of surgery. This allows patients to have less anesthesia during the surgery and very manageable pain after the surgery.

“Patients are up and moving around within a few hours with very little pain,” she says. “This not only gives them a head start on their recovery, but it also gives them the confidence that they can do all these things without a problem. When the medicine wears off, it is not nearly as overwhelming and they continue confidently with their physical therapy (PT).”

Paul was able to manage pain after surgery without opioids. Instead, he used Tylenol, ibuprofen, and minimal prescription nonnarcotic pain medication.

“The majority of patients are happy they can go home the same day,” says Kelsey Byron, PA-C, a physician assistant who works with Dr. Boisvert. “I had one woman tell me, ‘I feel like I can recover better in my own environment.”

“Patients are up and walking the very same day of surgery, with a walker or crutches, whether they stay overnight or go home,” Dr. Boisvert says. “Most patients will typically achieve good results and are back to some regular activities around six weeks, and doing really well around three months.”

Road to Recovery

Two days after knee surgery, Paul began physical therapy. Postoperative PT is critical for a successful outcome following knee replacement surgery.

“It helps to overcome pain, ensure optimal range of motion, minimize scar tissue, and help people get back on their feet,” Dr. Boisvert says. “Preoperative PT can also be very helpful for people dealing with pain for a prolonged period. These patients can develop changes in their gait and weakness in their leg due to a lack of use from long-standing arthritis and pain that can make their postoperative course more difficult.”

Initially, therapists from a home health agency came to his home. He soon transitioned to outpatient PT two days a week at the Clough Family Center for Rehabilitative and Sports Therapies in Westford.

“I did that for seven weeks and the team was great,” he explains. Things went so well with the surgery and PT that Paul was soon back in the swing of his life and work. “I went back to work fairly early. I started a project about five weeks after the operation.”

Dr. Boisvert says, “He was very motivated and wanted to get back to work as soon as he could. Everything worked out well for him.” Many patients of Dr. Boisvert have hip or knee replacements. These orthopedic surgeries can be done in a same-day procedure.

A New Offering

Same-day surgery for joint replacement is a new offering at Emerson Hospital.

“We have developed protocols with the pharmacy to utilize a long-acting injectable numbing medicine at the time of surgery that minimizes pain postoperatively and negates the need for prolonged hospital stays,” says Dr. Boisvert. “The operating room and hospital staff, including nurses, physical therapists, and occupational therapists, have adapted extremely well and are very enthusiastic about being a part of this program and ensuring the patient’s success.”

Patients like it.

“Especially now, minimizing stays in a hospital or rehab setting is appealing to most people,” Dr. Boisvert says. “When they go home, they are more likely to be up and around, which minimizes the risk of some postoperative complications, like blood clots or pneumonia. Most people are more comfortable in their own homes, and can manage their pain and recovery more easily in that setting. I think it helps the patient feel more autonomous.”

Same-day surgery for joint replacement is not appropriate for all patients. The procedure is offered only to those who meet certain criteria regarding health status and support systems at home.