Fast-track joint replacements are becoming more common

Not everyone is a candidate, but certain individuals qualify for a fast-track approach to their hip or knee replacement surgery—that is, heading home on the evening of their surgery or the next morning.

C. Brittany Boisvert, MD

There are a few items to consider when evaluating a patient for fast-track surgery, says C. Brittany Boisvert, MD, whose orthopedic surgery practice includes joint replacements, along with sports medicine. “The patient needs to be in good physical condition, meaning they exercise regularly,” she says. “Next, individuals with medical conditions—heart-related, pulmonary or sleep apnea—are not candidates for a short hospital stay. We need to watch them for a couple of days to be sure they do not develop any complications.”

Finally, a fast-track patient should have a support system at home. “Ideally, there is a family member who can come to their aid if they need help,” Dr. Boisvert notes. The best scenario is when the patient attends a joint replacement class at Emerson and brings a family member along.

“I encourage all patients to attend the class; that way, they understand the recovery process, including the use of walkers and canes, and how to prepare for surgery. Today, this includes showering with anti-bacterial soap prior to surgery. We want people to be familiar with everything that will happen before and after their surgery.”

Some individuals require additional preparation—losing weight—before their surgery can be scheduled. “Someone with a body-mass index [BMI] of 40 or above is at higher risk for a poor surgical outcome and certain complications,” says Dr. Boisvert. “We can work on it together, and I frequently refer patients to the Emerson Center for Weight Loss. In some cases, a patient loses weight, their knee pain improves, and they don’t require a knee replacement.”

For those who do, a pre-surgical exercise program often helps. “We want patients to be primed and ready for their PT afterward, which is an important step to a good outcome.”