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Introduction: Another edition of our integrated system podcast series, helping us to achieve world-class accessible care and to improve the health of the people we serve. This is Expert Insights. Here's Melanie Cole.

Melanie Cole: Welcome to expert insights with the Carle Foundation Hospital. I'm Melanie Cole today we're discussing orthopedic hip and knee replacements, Outpatient. Joining me is Dr. Michael Moran. He's an Orthopedic Surgeon with the Carle Foundation Hospital. Dr. Moran, I'm so glad to have you with us, and this is a great topic, but before we get into outpatient surgery, tell us about the current state of joint pain and injuries today. What's the prevalence of people affected by osteoarthritis and things that break joints down?

Dr. Moran: With our aging population and with older, active adults wanting to be out there playing sports, going for long walks. We see many more people these days coming in and seeking relief for their joint pain. It's definitely an increasing need in our society to keep our older adults more active.

Host: Well, it certainly is. And it's so important to keep that functional movement. So then tell us about the recent advances that are making outpatient total joint replacement a reality.

Dr. Moran: With the movement towards faster recoveries and safer surgery. We have had advancements in surgical techniques, surgical implants, and surgical techniques, medications, both before and after surgery, all of which work together to give the patient a safer recovery and a faster recovery. And we have gradually decreased the length of stay within the hospital for a hip replacement or knee replacement down to the point where we're now able to discharge patients just a few hours after surgery. It's something that's really been a dramatic improvement and benefit for our patients

Host: As it is a benefit for patients. Tell us who else this emergent outpatient delivery model is driven by. Is it, is it increased convenience for both patients and the staff? Satisfaction? Is it a cost reduction? Tell us a little bit about how this model came to be?

Dr. Moran: In medicine we're always moving forward and it's a gradual evolution as various parts of the patient management scheme improve. We move forward and say, well, the patient could go home maybe a day earlier. And then a few years later as patients enjoy the benefit of sleeping in their own beds, eating their own food, being with their loved ones, we saw there was a patient desire to go home because patients were ready. It got to the point where surgeons around the country saw well, okay, patient had surgery a few hours ago. He or she is doing well. They want to go home. Well, let's do it. Let's send them home. And very gradually surgeons around the country saw that it was safe and clinical studies documented the safety of outpatient surgery as well. And so now here in the champagne Urbana area, there's an awareness and a desire from patients to move forward and get the surgery done, and get it done as an outpatient.

Host: Well, then tell us how that's made possible. Tell us a little bit about staffing and strategies you employ to optimize patient recovery after outpatient total joint replacement.

Dr. Moran: It's really a team approach. From the surgeon standpoint, we rely on our nursing staff and physical therapy staff to educate the patient before surgery. So that the patient has a lower level of anxiety coming in to the hospital and a lower level of concern that they might not be ready to go home on the day of surgery. So there's all this preparation that goes on beforehand and there's patient selection that's very important. Certain patients just can't do it. If someone has poor balance or has limited support at home, or has medical conditions that prevent them going home on video surgery, they're not headed down that path. They're kept at one night in the hospital for safety reasons. But if the patient selection is right for that patient, then everything gets mobilized, so that the nursing staff and the operating room staff all works towards getting the patient ready for the surgery and then mobilized immediately after surgery. And every person on that team is really crucial so that everything gets done safely.

Host: Now how about some of the advances in total joint replacement, implants, and even techniques Dr. Moran, that you'd like to share with other providers to let them know what's going on in the field and what's exciting.

Dr. Moran: The materials have improved. For example, there's titanium implants that the bone grows into for the hips, that is become extremely reliable and safe to implant. And there've been materials for the ball and socket of the hip that are more durable than they were a few years ago and easier to put in. The instruments to place implants through a smaller incision, have gradually evolved to the point where we can use a smaller incision and maintain the muscle connections. So the joint works. It works that same day because the muscle connections are preserved. In the knee area, it's a similar thing. There are techniques now to make measurements through a smaller opening into the knee, maintaining the muscle connections better. So the knee works better that same day and both of the surgeries, whether it's a hip replacement or a knee replacement, it's really not just resurfacing the bones. It's measuring the tension in the surrounding soft tissues so that they're comfortable, so that they move the way a normal joint moves. And both of the operations, both the hip and the knee, they're really operations of many measurements, many assessments during the procedure in a very efficient fashion so that the surgery is not a very long surgery. And so we're able to do things more efficiently with these newer instruments for measuring and assessing the range of motion in the surgery. While we're looking at the components in front of our eyes, and we get the surgery done more efficiently with these newer instruments.

Host: Isn't the technology amazing what an exciting time to be in your field. Dr. Moran, and I think a very common question now, especially with outpatient joint replacement, what's changed about how pain is managed after this type of outpatient surgery. You mentioned it a little before, expand on it, if you would.

Dr. Moran: Yes. The medication aspect that can't be overemphasized, we placed anesthetic medication within the joint so that there is less need for opioid medication after surgery. We use very little and that decreases the incidence of patients having limited balance or nausea or other problems that can arise with opioid medication. We use medications that decrease the inflammation within the surgical site, that we did not have five years ago. So these medications we've tailored the dose. So it's just the right amount without any systemic effects to the whole body, just enough so that it works within that joint and the patient feels more normal. The patients that we see, both in the recovery room and as they're walking down the hallway, just a few hours after surgery, these patients have much less nausea. They feel good. They're ready to go home. They're comfortable. This is something we didn't have five years ago. So now it's gotten to the point where we're able to offer this to our patients, including now patients in their seventies, we used to only do outpatient surgery for much younger patients. Now patients in their seventies can have outpatient surgery and go home on that same day.

Host: Well, thank you for that. What an important point. So as we wrap up, what can other providers tell their patients to do before surgery to prepare so that it will be a more successful outcome? And while you're telling us that, tell us how some of your outcomes have been.

Dr. Moran: I'll say that our outcomes have really been excellent. I've been very encouraged by the comments that we receive from patients who say I was able to play with my grandchildren that same day. I was able to go to the park within a few days. Patients want to feel healthy and the whole mindset of a joint replacement has changed. You know, it's not an operation on sick people, the concept of you being in a hospital and being sick, and then being in a patient gown, we've changed that where it's a surgery on well patients. We have patients in their street clothes very early. It's an idea that this is a an operation for healthy people, including people up into their seventies and even into their low eighties, you know, patients enjoy it, the staff enjoys it. It motivates the staff as well to do better. And every member of the team from the nursing staff to anesthesia is part of that effort.

Host: Well, thank you so much. What great information Dr. Moran, and thank you for sharing your expertise on outpatient joint replacement with us. That concludes this episode of Expert Insights with the Carle Foundation Hospital. For a listing of Carle provider's and to view Carle sponsored educational activities, please visit our website at carleconnect.com for more information, and to get connected with one of our providers. We hope the information gained will be applicable to your work and life. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. I'm Melanie Cole.