Category Archives: Joint Replacement

There’s No Place Like Home After Surgery

recovering-at-homeTraditionally, patients and doctors have opted for in-patient rehabilitation after total hip or total knee replacement surgery, despite the high costs. However, recent studies found that after joint replacement surgery, patients who live alone are happier and fare just as well, and possibly better, when recovering at home rather than staying at a rehab facility. 

The study, published by the American Academy of Orthopaedic Surgeons, examined 769 patients who had undergone primary total hip replacement (THR) or total knee replacement (TKR). About 18% lived alone, all of whom were discharged home for outpatient rehab. Of these, almost 80% had friends or family nearby that could help provide support if necessary. 

Overall, there was no significant difference in complications, pain, functional outcomes, or patient satisfaction scores between people who lived alone and those who lived with others after the surgery. However, when recovering at home instead of spending an extra night at a hospital, patients saved an average of $10,776, amounting to almost $1.5 million total. Patients recovering at home were also found to avoid other complications — such as infections and blood clots — that they might experience in a rehab facility. 

“We found that patients living alone were able to safely recover without any increase in the rate of complications,” said Dr. William J. Hozack, an orthopedic surgeon who presented the study at the American Academy of Orthopaedic Surgeons. “Even more strikingly, patients were generally happy and content being in the comfort of their own home during recovery.” 

Recent Australian research corroborated these results. To test whether a rehab facility offered more benefits than a home-based program, the research team randomly selected 81 knee replacement patients who received both inpatient rehabilitation and home-based care, and 84 who only received home-based care. There were no differences in pain, function, or quality of life six months after surgery between the groups. 

These studies conclude that given the emotional benefits, the lack of complications, and the cost savings, outpatient recovery can be a beneficial option for total joint replacement patients who live alone. 

Struggling with joint pain? Interested in learning more about your post-surgical options? Dr. Stickney, a Kirkland orthopedic surgeon, specializes in procedures including total knee replacement. Contact his office today.

Staph Infection Heightens Risk of Surgical Complications

staph-infectionInfection after joint replacement surgery is a terrible complication that often results in subsequent surgeries with extended morbidity and rehabilitation. The possibility of infection after joint replacement depends to some degree on the patient’s immune capabilities, with the incidence ranging from 1.5 to-6% over a lifetime.

One of the leading pre-operative risk factors in orthopedic patients is the presence of Staphylococcus aureus (S. aureus), or staph, on the skin or nasal cavity. Most postoperative infections after joint replacement are the result of bacteria from the patient’s skin falling into the wound during surgery. In most cases, the immune system is able to eliminate those bacteria, but staph carriers are two to ten times more likely to face infection.

Pre-operative skin washing at home, skin scrubbing in the operating room, and intraoperative surgical irrigation and antibiotics help minimize this risk. Patients with staph chronically growing on their skin are at higher risk due to the aggressive nature of this bacteria and the heightened risk of wound infection. On average, 18-25% of patients will have staph on their skin chronically, and of this group, approximately 11% have a strain resistant to antibiotics.

A recent study done at NYU Langone Medical Center analyzed 13,828 orthopedic patients between 2009 and 2016. In this study, patients were tested preoperatively for the presence of S. aureus, with 18% testing positive for colonization. The researchers also found that 4.35% of the colonized patients developed surgical site infections (SSIs) after surgery while only 2.39% of non-colonized patient’s developed SSIs postoperatively. Specifically, patients who had undergone total knee replacement surgeries were 380% more likely to develop a postoperative infection if the patient was colonized with S. aureus prior to the procedure.

This information points to the importance of understanding who is at higher risk of a post-operative infection. Developing methods to minimize this prior to surgery also helps combat readmission, revision surgery, longer hospital stays, and increased medical bills.

Questions about joint replacement surgery? Concerned about your orthopedic health or interested in taking steps to protect it in the future? Dr. Stickney is a Kirkland orthopedic surgeon who can help find the best surgical and nonsurgical options for you. Contact his office for an appointment today.