Home safe and sound the same day as hip replacement

In July 2018, Sally Chandler, 64, of Falmouth became the first patient to be discharged from Cape Cod Hospital on the same day as her right hip was replaced. It all went so well, she was already planning her left hip replacement with same day discharge home.

“Everything went so smoothly, everyone was really nice and I had a very positive experience that whole day,” said Chandler.

“This is groundbreaking for Cape Cod and possibly Massachusetts,” said Leonard Remia, MD, the Cape Cod Hospital orthopedic surgeon who performed her surgery. “There may be one outpatient center outside of Boston that may be doing some.”

Since then, Falmouth Hospital also discharged its first joint replacement patient on the same day as surgery.

Dr. Remia performed a minimally invasive hip replacement on Chandler using an anterior (frontal) approach with a smaller incision, rather than the traditional hip replacement using a longer incision on the side of her hip.

The difference in surgical techniques, coupled with changes in anesthesia using nerve blocks to numb your leg and combinations of medications such as intravenous Tylenol, Ibuprofen and other non-narcotic medications to control pain, promotes faster healing, according to Dr. Remia.

“The minimally invasive surgical techniques cause much less trauma to the body and tissues,” he said. “Patients don’t feel as much pain and there is less damage to the soft tissues.”

The goal with every patient, and especially a patient going home on the same day of surgery, is to make sure they are able to take care of themselves and do it safely, he said.

“We treat all of our patients with the same expectations. They are going to be up and moving the same day of surgery as well as walking.”

Chandler was walking within a few hours of surgery.

After she awoke from surgery, she was transferred from the recovery room to a room on the sixth floor of the Mugar patient wing at the hospital. She jokingly said if she had known the room was going to be so nice and have such a great view of Lewis Bay, she wouldn’t have wanted to go home.

“They gave me something to eat and then the physical therapist came in to make sure I could walk up and down the hall and the stairs,” said Chandler. “They had me use the bathroom, get dressed and then told me I was good to go. My operation was 8:30 that morning and I left the hospital by 3 pm.”

When Chandler and her husband arrived home, there was a nurse and physical therapist from the Visiting Nurse Association of Cape Cod waiting in her driveway to make sure she could get into the house and assess for home services.

While she had a little more pain on the second and third day, Chandler said she was glad she went home on the day of her surgery when the nerve block and other meds still made her comfortable even with all the movement. She was generally a little bit sore but she had no real pain in the incision or the implant.

Following two weeks of physical therapy at home and then outpatient therapy, she was back doing yoga and other activities.

“I have no complaints,” Chandler said.

The criteria for same day discharge

In order for a joint replacement patient to go home the same day, they must be motivated to do so, according to Dr. Remia.

While most patients will be in their 60s and 70s, because they are the groups who tend to have degenerative osteoarthritis, he’s not ruling out older patients who are healthy and active for same-day discharge.

“Our goal is to send patients home who we know are going to be safe and who are going to do very well with few complications,” he said.