Total Joint Replacements

Studies show complications better treated in hospital setting

DAVENPORT, IOWA - Having outpatient surgery is a trend that’s sweeping the nation. Some even suggest that you have your hip or knee replacement surgery as an outpatient.

Sounds convenient, but is it safe?

At least two studies over the past year suggest maybe not. Although total joint replacement is a safe and successful procedure, certain life-threatening complications can develop in the first days after surgery. Such complications, impossible to predict, call into question whether it’s safe for patients to undergo total joint replacement in an outpatient setting.

“The point of these studies is that complications from total joint replacements are unusual and rare. Some of the complications,  however, can be life-threatening,” said Joseph Martin, M.D., of Orthopaedic & Rheumatology Associates, P.C. “About 80-90 percent of complications happen in the first two days after surgery, and it is very difficult to identify which patients will have them. Most complications, promptly treated in the hospital setting, cause no long-term problems.”

Most recently, a study presented at the annual fall meeting of the American Association of Hip & Knee Surgeons in Dallas collected data on 15,383 total joint replacements. Of those, there were 486 major complications. A majority of those complications happened within two days after surgery.

In addition, a study published in the January 2007 Journal of Bone Joint Surgery found that 58 percent of the patients who had life-threatening complications “had no identifiable predisposing factors.” It concluded that complications associated with total joint replacement usually occurred within the timeframe of a typical hospital stay. “Given the serious nature of some of these complications and the inability to identify many of the patients who may be at risk, we caution against early discharge of patients,” the study said.

“One conclusion that can be drawn from these articles is that it may be advantageous to have your minimally invasive joint replacement in a hospital setting, where resources are immediately available to turn a potentially life-threatening complication into a minor event. Having your replacement in the hospital does not slow your recovery in any way,” Dr. Martin said.

“Total joint replacement in a hospital ensures that there is a thorough evaluation by the doctor, nurse and physical therapist prior to discharging home,” he added. “Outpatient total joint surgery should not be allowed to compromise safety of the procedure in any way. While we have the ability to numb people up and send them home, it may expose patients to unnecessary risk.”

Although ORA and Genesis Medical Center have a new ambulatory surgery center at 18th Street and 53rd Avenue in Bettendorf, ORA surgeons still take the ultimate safety precautions and perform total joint replacements at the West Central Park campus of Genesis  Medical Center.

There, the seventh-floor Orthopaedics Unit recently underwent a three-month renovation that included new paint, flooring, wall coverings, ceiling and lighting, a new, larger, centralized nursing station, and new furniture for patient rooms.

Orthopaedic and Rheumatology Associates, P.C., has served patients in the Quad Cities for more than 40 years. The practice is the largest of its kind between Chicago and Omaha, recording more than 100,000 patient visits each year at offices in Bettendorf, Davenport, Moline, Silvis, Muscatine, Durant, DeWitt and Geneseo.

###