Daniel Capen had surgery to replace an arthritic hip one early morning. By noon, he was walking.
That evening—less than 12 hours after the operation—he was home in Manhattan Beach, watching sports and eating pasta. A week later, Dr. Capen, a 61-year-old orthopedic surgeon specializing in spinal disorders, resumed his busy practice.
A Quick Recovery
“Most people who undergo hip replacement surgery at the MemorialCare Joint Replacement Center at Long Beach Memorial recover quickly and easily, with minimal pain,” says Douglas Garland, M.D., the Center‘s medical director and Dr. Capen's surgeon. “Although Dr. Capen’s outpatient hip replacement surgery was unusual, it will become commonplace in the future.”
The reason for this dramatic improvement is a unique, comprehensive system of interactive care that leads to rapid recovery. “Almost all patients at the MemorialCare Joint Replacement Center walk with assistance just hours after surgery and leave the hospital in two or three days,” Dr. Garland says. “For younger, highly motivated people like Dr. Capen, hip replacement can be an outpatient procedure.”
The specialized program used at the Center owes its effectiveness to a combination of education, novel pain management strategies, expert postoperative therapy and a less-invasive approach to surgery. Dr. Garland explains that all the components work synergistically, leading to rapid discharges and superior outcomes.
Prior to hospitalization, patients and their families attend a two-hour educational session to understand the joint replacement process, including the importance of walking the day of the procedure. They also learn the role of the patient’s “coach.” This may be a friend or family member who accompanies the patient through the program and helps with daily tasks and physical therapy during recovery. “The pre-op classes play a major role in making the program a success,” Dr. Garland says. “Everyone is fully prepared.”
The operation itself takes about an hour. In general, the incision is one-third the size of a traditional opening, leading to less tissue trauma and blood loss. But Dr. Garland notes that even when a longer incision is required— in larger patients, for instance—rapid rehabilitation is just as successful. “Incision size is the smallest part of the equation when it comes to rapid recovery,” he says.
Far more important are the use of regional anesthesia and preemptive, non-narcotic pain medications. This includes acetaminophen or non-steroidal drugs given during surgery or in the recovery room. “When patients don’t have to recover from general anesthesia or battle pain and nausea, they start physical therapy sooner,” Dr. Garland explains. “Attentive nursing care and physical therapy immediately after surgery reinforces the concept of wellness.”
Dr. Garland stresses that the MemorialCare Joint Replacement Center program is suitable for most people, including those in their 70s and 80s. It’s also attracting a number of 40- and 50-year-olds. “Thirty years ago, joint implants weren't expected to last more than a decade,” he explains. “People had to wait for surgery until their 60s and hope they wouldn't outlive their new hip.” Today's prostheses are more durable, making hip replacement increasingly popular among active baby boomers.
“The vast majority of patients go directly home after discharge. For the most part, a skilled nursing facility is now only necessary for individuals who are medically unstable or live alone,” says Dr. Garland. And many hip replacement patients are able to forgo formal physical therapy. “Patients are given a detailed physical therapy program they follow at home with their coach's help,” explains Dr. Garland. “We work extensively with them before they leave the hospital. Within a month, most are walking unaided.”
Dr. Capen calls his experience at the MemorialCare Joint Replacement Center amazing. “I had my surgery at 7:30 a.m. Five hours later I walked, ate lunch and walked some more, logging one-half mile before I was discharged. I practiced climbing stairs and getting in and out of a car. Everything they do contributes to a quick and successful outcome— from anesthesia and pain management to superb therapy and nursing care.”
Back To Normal
Once home, Dr. Capen continued to progress rapidly. “Each day, I walked longer distances. My son, Nick, who was my coach in the program, stayed with me the first week. After that, I was driving and doing everything on my own.” Six weeks after the operation, Dr. Capen provided charitable surgical care to needy Peruvians and hiked Machu Picchu. He’s become even more active since his second hip surgery in November. “I expect to be skiing by February or March,” he says. “My progress so far has been unbelievable.”
For a referral, visit the MemorialCare Joint Replacement Center.