The short answer is yes. Overall, approximately 60% of our patients are discharged home the same day, utilizing our rapid recovery protocol. If you are over 80 and have medical problems, plan on spending a night or two. The ideal candidate for same day discharge:
- Motivated. A positive attitude and willingness to follow our post-surgery instructions will increase the likelihood of a good outcome.
- Mobile. Patients who are active and independent before surgery will have better mobility immediately after the procedure and will require less assistance. Patients who require a walker before surgery will be better served with a brief inpatient stay.
- Healthy. Patients without chronic medical problems, such as heart or lung disease or diabetes. Those dependent on opiates for chronic pain may be better suited for an inpatient setting.
- Supported. Family or friends should be available to help and encourage.
- Less pain. Rather than using pain pumps and IV medications, our patients have spinal anesthesia as well as a long-acting local anesthetic that lasts 2-3 days. In addition, the knee patients receive an adductor canal block that lasts about 8 hours.
- Lower infection risk. Spending less time in the hospital lowers the chances of infection, especially during a pandemic. Patients are used to the bacteria in their own homes.
- Better recovery at home. Leaving the hospital means allows patients to recuperate in the comfort of their own home. They progress better in a familiar environment and are more likely to get a good night’s sleep.
The Institute for Joint Restoration was founded on a commitment to employ the very latest and proven methods in joint replacement with individual and compassionate patient care. We specialize in primary hip and knee surgery, along with complex revision surgery. This is all we do, and our outcomes are unmatched.
In fact, ours was the top rated joint replacement program in California by Healthgrades in 2011 and has continually received the highest marks for nearly two decades. If you live outside the area, you will be one of the 85% of our patients who travel here to participate in our program.
Yes and no. We do not teach medical students or residents at our facility, although many orthopaedic residents attend our presentations at national meetings and read our research studies. Research and teaching is a valuable part of what we do, but we believe that resident physicians must first master the anatomy and surgical techniques through constant repetition. Until then, they will operate through larger incisions than we employ and require constant supervision.
We do, however, participate in the teaching of practicing orthopaedic surgeons who want to refine their techniques or learn more streamlined methods for joint replacement care. We regularly host site visits and our operating rooms are equipped with video cameras and monitors for teaching purposes. Of course, visiting surgeons may only observe the surgery and their presence in the operating room requires patient consent. Many of our patients take advantage of our video system and observe their own surgery.
An evaluation by a physician is useful if you have hip or knee pain, joint stiffness, limitations in activities, trouble sleeping, or decreasing function. When simple measures such as the use of anti-inflammatory medications or injections are no longer effective, it is time to give us a call. We often recommend that patients make a list of the things they cannot do as well as they’d like, and when that list is too long to live with, surgery may be the answer. A physical exam and x-ray will allow us to discuss with you whether joint replacement is the next appropriate treatment option.
The short answer is no. For patients with arthritis isolated to a single compartment of the knee, partial knee replacement may be a better surgical option. While total knee replacement has excellent outcomes, if only part of the knee is worn out, often the rest can be preserved, allowing for a less traumatic operation and a more normal feeling knee. In the U.K., over 50% of knee replacements are partial replacements rather than total knee replacements.
All surgery poses certain risks. Fortunately, the chance of a significant complication with joint replacement is very low. The risks specific to hip and knee replacement surgery involve primarily the cracking of the bones during the preparation or implant insertion process. Blood clots in the deep veins of the legs can also develop after surgery, although this is very unusual. Rarely, a clot in the leg can travel to the lung. Other risks that can occur with any type of surgery include damage to nerves and blood vessels and infection. Allergy to the implant materials is exceptionally rare, described on a case report basis. For a complete discussion regarding the complication rates after joint replacement surgery, please download our hip brochure or knee brochure.
Primary joint replacement, as opposed to revision joint replacement, generally takes less than an hour in the hands of a specialist. The steps involved in both hip and knee replacement are consistent and easily streamlined in a high-volume setting. Speed is important, since infection rates are directly linked to the amount of time the skin is open. Accuracy is even more important, however.
Because of the narrow focus of our program and our tremendous experience, we have been able to combine accuracy and a streamlined approach to surgery, with surgical efficiency being a desired by-product.
Over 900 joint replacements are personally performed by Dr. Dearborn at the Institute each year. Many studies have shown that improved outcomes with reduced complications are achieved when joint replacement is done by high-volume surgeons, at high-volume hospitals.
In contrast, the majority of joint replacements performed in the United States are performed by surgeons who replace fewer than ten joint replacements per year.
Yes we do. Our PAs are highly skilled and experienced orthopaedic specialists. They know more about joint replacement surgery than most orthopaedic residents and many attending physicians, and they function a bit like residents in our program. They participate in the preoperative and postoperative care of our patients, they assist in surgery, and they help our patients get their questions answered more quickly and efficiently. Unlike resident physicians, who rotate to new hospitals and new attending physicians every few months, ours are on the same team constantly, year after year, in close communication with Dr. Dearborn at all times.
After the operation is complete, patients generally spend one hour in the recovery room, just until the spinal anesthetic wears off. Knee patients have a nerve block placed before the surgery, which makes for a comfortable postoperative stay.
Patients are then transported to the Center for Joint Replacement (CJR) building, our quarantined unit with all private rooms. Both hip and single-knee patients will be up and moving a few hours after arrival on the unit, guided by one of our expertly trained Physical Therapists. While on the unit, important stretching exercises will be emphasized, as well as techniques for doing routine tasks independently. Most patients are then discharged within 4-5 hours, though for certain patients, an overnight stay may be required.
Our bilateral knee patients generally start physical therapy the evening of surgery and should plan to spend the night.
Over 95% of patients are discharged directly home from the Institute. Homeward-bound patients are safe, comfortable and walking. Availability of family or friends to help with food preparation or household chores is beneficial for the first few days after discharge, especially. In the infrequent situations where safety is an issue or help is not available, our case manager specializes in facilitating brief rehab stays. In general, skilled nursing facilities should be avoided because of the risk of antibiotic-resistant bacteria known to colonize long-term residents at these facilities.
Yes. Many of our patients are discharged using a cane for assistance and some need a walker or crutches. For hip replacement patients, other special equipment is helpful for dressing and reaching items on the floor. Raised toilet seats are a nice convenience. Knee replacement patients may find cooling units very helpful to reduce knee swelling.
All equipment will be provided by the Institute therapy staff and most is covered by insurance.
Expect to be seen in our office about two weeks after surgery, then at six weeks, and again at three months, depending on your surgery type and progress. We also suggest an evaluation at one year and then every other year after that, as recommended by the FDA. Typically these visits will include us taking updated x-rays of the affected joint. Patients living a long distance away can have these follow-ups performed via telemedicine.
Yes. The therapy begins in the hospital and will continue at home. The Institute physical therapists will highlight the specific exercises to focus on from the education binder. A physical therapist visits our patients at home to ensure optimal continuity. Our knee patients generally need formal physical therapy in an outpatient clinic near their home as well, which we help facilitate. In some ways, what our patients gain from their successful surgeries is heavily influenced by what they put in, especially with regard to preoperative physical preparation and consistent, appropriate postoperative exercise.
Most patients are able to walk without assistive devices within 2 – 3 weeks, which means that balance has been restored and hands are freed to be useful. At the 6-week point, patients are able to resume regular activities, including golf. Tennis players will need to wait three months to begin hitting from a ball machine or simple volleying. To resume skiing, expect 4 – 6 months.
In general, the need to redo a hip or knee replacement occurs at a rate of less than 1% per year. Implants can fail due to wear or loosening from the bone. Replacements that are done well, using modern materials, should last over 20 years in most patients.
The implant failure rate depends on patient activity, age, weight, and patient characteristics (such as bone quality, muscle and ligament strength, and others). The plastic liners are highly durable, but if wear occurs, they can be removed and changed without disturbing the metal components. If necessary, one or both sides of a joint replacement can be replaced.
The short answer is yes. We are contracted with all of the major insurance carriers, including Medicare. Patients with Medicare plus a supplement usually have negligible out of pocket costs. Due to the variability of private insurance plans and deductibles, out of pocket costs may vary. It may be useful to contact our billing department (510-818-7230, lovelle@dearbornassoc.com) or your employer’s insurance liaison with questions.
