Hip and knee surgery


Preferred by patients, encouraged by regulators, acknowledged by scholary societies, outpatient prosthetic surgery has become a reality.
It is the ultimate objectif of the ERAS (Enhance Recovery After Surgery).
The second semester 2016 will have seen this surgery become an indispensable element of my hyper-specialised surgical activity.

Have a look at what the medical press says : here

In practice it's offering patients the replacement of their hip or knee during outpatient surgery, allowing to return home the same day as the operation.
This supposes they do not live alone nor present any conditions of the heart or endocrine system that could worsen. The pre-operation consultation will allow us the evaluate if you are eligible for such surgery. You should know that it can now be proposed in more than half the cases.

Older age is not a contraindication to performing such actions and is even more likely to be an excellent indication, thus avoiding the problems of prolonged hospitalization.
You can read here what the high medical authorities think about that.

In Marseilles, this surgery is performed at the Monticelli-Vélodrome clinic which was opened in 2016. This ACS (Ambulatory Surgical Center) offers a structural organisation firmly oriented towards outpatient surgery.
Find more details : here.

All of the ambulatory hip and knee arthroplasties I proceed in Marseille are made in this hospital particularly suitable for such surgery as evidenced by this article.

What is Ambulatory surgery ?
Ambulatory surgery means a specific care pathway that enables to shorten the hospital stay for a surgery to one day maximum. This means you enter the hospital in the morning, you get your surgery and you exit in the afternoon or so. Hence, your hospital length of stay will be less than 12 hours.

Why does Ambulatory surgery enhance the quality of care ?
• Because surgery techniques have significantly evolved during the past decade, in particular with the use of mini-invasive techniques. Those surgery techniques enable less trauma with the same care result : smaller scars, less drains. The ambulatory surgery favors these mini-invasive techniques.
• Because anesthesia techniques have also made significant progress reducing nausea and pain level while getting a rapid wake-up and short recovery time length. To do so, anesthesia techniques for ambulatory surgery are using a multimodal process combining local anesthetics with anti-pain drugs that increase analgesic effect while removing side-effects. The fasting is reduced to the minimum, usually 6 hours for food and 2 hours for these following beverages : tea, coffee, apple juice, water, syrup.
• Because the ambulatory surgery creates a lean management process within the medical team : there is no wasted time, each step of your care pathway is thoroughly controlled. In few hours, you will go through the administrative paperwork, the surgery intervention, the wake-up process, the fast recovery process to be able to get back home walking on your own, and finally the legal paperwork for your exit sign-off. This whole process requires a very efficient team organization. The team has to anticipate and prepare your care pathway, and will communicate very well with you as well. Ambulatory surgery is a seamless medical process.
• Because being able to get back home on your own means that your wake-up phase is thoroughly controlled.
• Because dressings have been optimized and drains have been removed.

What is the patient feedback about the ambulatory surgery ?
All outpatient satisfaction surveys show excellent feedback, and outpatients would unanimously choose the same type of surgery process. This fact has been stated by the non-profit patient organization CISS : this study reports collective as well as individual advantages. In essence :
• Individually wise, advantages are: getting back home earlier, shortening of the hospital stay, less risks of nosocomial infection, less risks of post-surgery thrombose
• Collectively wise, advantages are: promoting care centered on the patient, enhancing the medical team coordination including nurses, physicians, physiologists and finally saving healthcare costs. This CISS organization strongly promotes ambulatory surgery and suggests that medical professionals inform patient that this medical process is the by-default process, hence, hospitalization should be chosen only in exceptional cases. In 2001, the French Medicare institution (CNAM) performed a global survey on thousands of patients who have experienced an ambulatory surgery. This survey studies a myriad of parameters such as re-admission rate level, number of consultations, number of drugs prescribed, the time length of sick leave,… It reports crystal clear benefits of ambulatory surgery and all surveyed patients are expressing a warm enthusiasm about this medical process : they are willing to choose this process for their next surgery, if any.

How to get prepared to my ambulatory surgery and to my return home phase ?
Here is some advice :
• Make sure you’ll have your full health file with you when you visit your surgeon or anesthesist, including your last treatment prescription
• Read carefully all the directions given by your medical team
• Make sure you have written down all the questions you have so that you won’t miss one during your surgeon visit. All questions, even the dumb one ! The more questions you have, the more answers you get and the more relaxed you will be
• Plan in advance to pick-up your medicines at the drugstore, so that you won’t experience a last minute extra stress due to medicine shortage or closed drugstore
• Prepare ice pockets in your freezer if your surgeon advised you to cool down your operated zone
• Prepare light meals for your lunch and dinner to get rest after your surgery
• Bear in mind that you must not make any key decision after a full anesthesia

Will hospitalization exist in the future ? how does traditional hospitalization cope with new medical processes ?
Actually, hospitalization is not anymore mandatory to get a surgery. Today, 1 out of 2 surgeries is performed using the ambulatory techniques. In the near future, ambulatory surgery will represent the wide majority of surgeries. Traditional hospitalization will still be required for heavy and vital interventions such as organ transplantations, cardiac or lung or neuro surgeries, reanimation interventions… The roadmap of future hospitals is definitely setting ambulatory surgeries as the standard of surgery. The associated savings will enable us to allocate more budget to heavy pathologies.

Is ambulatory surgery safe ?
This type of surgery is as safe as traditional surgery, and even safer. Ambulatory surgery reduces nosocomial infection risks as well as phlebitis risks. Providing the same quality of care in few hours instead of few days makes the process leaner and safer.

Is ambulatory surgery relevant for everyone ? Am I eligible to the ambulatory surgery ?
Absolutely ! Ambulatory surgery is relevant for anyone without any age limit. Ambulatory surgery is even recommended for elderly patients since it reduces the risk of mental confusion due to longer stay out of home. However, to get an ambulatory surgery there are minimal logistic constraints :
• To easily have access to a phone and to fully understand the medical team directions: you will need to be fluent in the appropriate language and have easy and adapted hygiene at home
• To have a companion to get you back home after your surgery
• To have a friend, a neighbor or a relative staying at your home for your first night after the surgery

Is it pretty risky to get out of the hospital right after the surgery ? Who will take care of my health status ?
There is no additional risk with an ambulatory surgery compared to traditional surgeries. When you are back home, you will still be connected with your medical team : your doctor will be well informed of your health situation as well as nurses, physiologists, chemists around you. The ambulatory team will also be available at any time either by phone, by internet, by a specific digital app to help you in case of any questions or issues. The ambulatory team will give you a call the day after your surgery to get information about your health status.

How can I have access to this ambulatory surgery ?
When you visit your surgeon, you definitely can ask for an ambulatory surgery even though this medical process tends to be the standard in most cases.

Is there any option I’ll spend the next night at the hospital ?
In most cases (98%), you will get back home for the night. In some rare cases, you will spend the night at the hospital: complications after the surgery, abnormal bleeding or nausea.

What am I going to do if there are complications at home ?
Your medical team will provide you with a full set of drugs, with directions for your post-surgery time, with a sick leave certificate and possibly with a digital application for your follow-up. It is not necessary to contact your doctor right after your return home. If you experience any issues, you can contact your ambulatory team by phone or through the digital app provided. A 24/7 phone number will be indicated into the set of documents you will be provided with. During your hospital exit, your surgeon will schedule an appointment with you : you can re-schedule it ahead of time if you wish. In addition, all your health documents will be sent over to your doctor right after your surgery. He will be able to adapt your treatment if necessary.

Everything will be planned and organised in advance so that you benefit from a short stay in the clinic in the best conditions.

What is an ACS ? (Ambulatory Surgical Center)

An exemple of hip and knee center like ours (U.S. state of Illinois)