Carl Maronich (Host): There have been a lot of advances in medicine, and some of those advances include same or next-day discharge following joint replacements. We're talking about that with orthopedic surgeon, Dr. Christopher Farrell, from the University of Maryland Baltimore Washington Medical Center. This is the Live Greater podcast series, information for a Healthier You from the University of Maryland Medical System. Dr. Farrell, welcome to the podcast.

Christopher Farrell, MD: Thank you, Carl.

Host: As I said, we're going to be talking about same-day or next-day discharge following a total joint replacement, which has to be a fairly new revelation in medicine. How has this surgery changed over the past, say, 10 to 15 years?

Christopher Farrell, MD: Yeah. Well, the essence of the surgery is the same. However, over the last 10 to 15 years we've always been trying to improve upon efficiency and speed in recovery, and that was really accelerated with the COVID-19 epidemic where we've tried to get patients out of the hospital and do things as safe as possible without having to admit them. And so, over the last few years, we've been able to reduce stays at the hospital after total joint placement from three to four days back about a decade and a half ago to now, we can do these surgeries safely in the right patients same day with same-day discharge.

Host: Yeah. Amazing. And, as you said, people formally in the hospital a much longer amount of time. When we talk about total joint replacement, what specifically are we talking about?

Christopher Farrell, MD: So, in a total joint replacement, we take the joint, which is, for example, take the hip, we take the ball of the femur and replace that with a metal implant. And then, we take the socket side of the pelvis and replace that with another metal implant and usually have some form of material such as plastic in between to allow the surfaces to slide and glide over each other much more smoothly than the arthritic hip. And it's a similar process in the knee.

Host: So, there may be some, I'm sure, patients who are better candidates than others for same or next-day discharge.

Christopher Farrell, MD: Yes. So, the same-day discharge would be most appropriate for certainly selected patients. Fortunately, most patients would fall under that category, who are in need of a hip or knee replacement. Those patients would generally be healthier, and go through a screening process to make sure that they could go home the same-day. If they're generally younger, less medical problems. They can have chronic medical problems, but as long as they're well managed, they can be safely discharged at home oftentimes.

Host: Leading up to something like this, what would be the early signs that someone may be headed for a total joint replacement?

Christopher Farrell, MD: Sure. So, some of those early signs would be pain in the joint. So about the hip, it's oftentimes pain in the groin side of the hip or buttock, oftentimes with activity, with long sitting, putting on socks or shoes. And that pain may limit them from their usual activities. In the knee, it's oftentimes pain directly around the side of the knee that's affected, but can be more generalized. The pain is usually affected by activity. Patients may limp, and may not be able to enjoy the things they like to do, like golf, tennis, or simply walking around the grocery store.

Host: Or skiing, which I understand is something you enjoy.

Christopher Farrell, MD: Yes, that's right. Yeah. It certainly can impact some of our younger, healthier patients in some of the sports that they do.

Host: Yeah. And to that point, has the age you're seeing of patients for these coming down or you think of it as kind of an older person's issue, but are you seeing younger folks who are needing these kind of surgeries?

Christopher Farrell, MD: Yeah. Yes, we do. So, many decades ago we were performing these mostly in elderly people. But now, the technology has improved, and we are able to do these in younger patients. And patients are very appreciative, because they want to maintain their activity, maintain their mobility, and continue to engage in the activities they like to do.

Host: Now, when it comes to same next-day discharge, what are the benefits of going home sooner? I'm sure there are a good number of them.

Christopher Farrell, MD: Yeah. So, there are a multiple number of reasons why it's better to go home if you can safely. And one of those is we're less likely to catch an infection from someone else. That's called a nosocomial infection. We also are getting patients up and active more regularly if they have to get up on their own at home. So, we're hopefully reducing the likelihood of a blood clot. And then, finally, patients simply like it. They're recovering amongst their family in a location they're familiar with, location that's more comfortable oftentimes. And we're treating these patients as if they're healthy, which they are, maybe just chronically disabled by a joint, an arthritic joint. But they're able to go home and recover in a situation where they felt and treated like they're healthy. They're not sick. They're coming in healthy and requiring a joint replacement, and they're going home healthy and with their joint reconstructed.

Host: Yeah. So obviously, a lot of benefits. But certainly, there are some risks when folks go home. And making sure the home's prepared for that, I'm sure, is one of those things.

Christopher Farrell, MD: Yeah. So, some of the criteria are we look at their overall health, but we also look at their social situation. So, it's imperative that someone has this social network and the health at home so that they can get through the first few days without too much difficulty. And some of that's just the simple things, like someone to help with maybe doing some laundry or preparing meals or just straightening up around the home. For those first few days, it's nice and it's really helpful to have someone around.

Host: I'm sure there are things also a patient should or needs to do prior to surgery to make them be in a better situation for the recovery.

Christopher Farrell, MD: Yeah. So, the education is huge and important in preparing folks for an outpatient procedure. So, preoperatively, it's important that we en engage and discuss that there's somebody going to be home for them to help, that there's appropriate equipment. So in the case of a hip replacement, oftentimes the toilet seat riser would be helpful to have at home and reviewing some of the gait aids like canes or walkers with our physical therapy department and learning some of the exercises before, because we don't have that opportunity to discuss that before they leave the hospital, oftentimes like we did when they were staying a few days in the hospital.

Host: All patients are different. There are a lot of variables that go into things, but is there any way you can give kind of a timeline as to what somebody might expect a recovery to be following surgery?

Christopher Farrell, MD: Sure. Yeah. So after a hip or knee replacement, they'll stay maybe a few hours in the hospital, one or two in the recovery unit. And with some of our newer techniques with anesthesia, we're able to get them up moving quickly. Physical therapists would work with them in the recovery room and in the post-op setting to make sure that they're safe, getting up out of bed and appropriately using their walker. And nurses would be making sure that they're able to tolerate their pain and their pain is well controlled with medicines they can take by mouth. Finally able to get out of bed with ease and climb stairs before they leave for home.

Host: Is it fair to say folks can expect to get back to a normal or any activity that they wanted to do or were doing prior to the surgery or what factors into that?

Christopher Farrell, MD: Sure. So for hip and knee replacement, we would recommend that patients get back to most of the activities they enjoy doing. I mean, we allow patients to return to golf, tennis, swimming, cycling. Those are all safe. If someone's an excellent skier, we allow them to get back to skiing, probably best to ski the greens and blues. If someone enjoys yoga, there may be in the circumstances of hip replacement, some positions which we may not want them to participate in. But for the most part, patients are able to get back to the activities they enjoy.

Host: They've kind of got to monitor on their own how they feel doing what they're trying to do. And I'm sure kind of listen to their body as we all need to do.

Christopher Farrell, MD: Absolutely.

Host: Doctor, we mentioned earlier, you enjoy skiing, tennis. What drew you, if I might ask, to this specialty in medicine?

Christopher Farrell, MD: Well, one of the greatest things about this specialty is we take a patient who may be healthy in other regards or managing chronic illnesses well, but then are suddenly debilitated by severe arthritis or pain in a joint. And oftentimes, in the circumstances of hip or knee replacement, we're able to replace that joint and return them to their prior activity level. And the satisfaction and the quality of life is greatly improved, and long enduring in most circumstances. So, that's really what I've really enjoyed and what drew me to this specialty and this subspecialty.

Host: Yeah, that's got to be very rewarding. Doctor, as we wind up, is there anything you wish you folks understood more regarding joint replacement surgery?

Christopher Farrell, MD: Yeah, I think that what about joint replacement is so great is that we can take somebody who's dealing with debilitating pain around their hip or knee and really allow them to get back to their prior activity level in most circumstances pretty quickly and with a high degree of satisfaction.

And it's probably the reason why hip and knee replacement is probably the top two or three procedures that we do in medicine, because it's so great in allowing patients to return to their former activity level.

Host: We've been talking to Dr. Chris Farrell, orthopedic surgeon, Dr. Farrell. Thanks so much for joining us today.

Christopher Farrell, MD: Thank you, Carl. thanks for inviting me.

Host: Find more shows just like this one at umms.org/podcast and on YouTube. Thank you for listening to Live Greater a Health and Wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again, and please share this on your social media.