When Beaufort Memorial set its sights on building an advanced joint replacement program more than 20 years ago, no one could have imagined the seismic shifts that were on the horizon—chief among them: same-day joint replacements.
At that time, the national average length of stay for a patient undergoing total knee or hip replacement was five days. When the hospital began to look for ways to improve the entire process, staff thought it might be a stretch to aim for a reduced, four-day length of stay.
They were wrong.
Following an intense “process-improvement” program, the team overhauled every aspect of the patient and surgical experience, from pre-operative education and registration to the surgery itself and everything that follows.
“Creating a new process was exciting and eye-opening,” said Dr. Kevin Jones, a board-certified orthopedic surgeon at Beaufort Memorial. “It really helped all of us to see the whole picture, to understand how to improve it for our patients and, ultimately, get them out of the hospital sooner rather than later.”
Their hard work paid off. Within 14 months, the average length of stay at the hospital’s Joint Replacement Center decreased to about two days. And today, a majority of joint replacement patients stay for one day or less.
Enter technology
Orthopedic surgeons have always been early adopters of new technology and approaches to joint replacement, beginning with the first joint navigation system in the early 2000s to the leading edge Mako SmartRobotics Arm-Assisted Surgery System for knee and hip replacement used today. At Beaufort Memorial, orthopedic surgeons use Mako to replace joints with pinpoint precision, allowing for better alignment, more comfort, and a longer-lasting joint.
“The Mako robot has been a game changer for knee replacement,” said Dr. Jones, who performed the first Mako hip replacement at Beaufort Memorial last year and has used the technology to perform nearly 300 knee replacements. “The results have been amazing. Patients are recovering faster. We are seeing similar outcomes with hip replacements.”
Clinical studies have shown the robotic surgery system improves outcomes by allowing the surgeon to customize the placement and alignment of the implant components to the patient’s unique anatomy, providing more natural movement of the joint and increasing its longevity.
Another benefit? A shorter length of stay. “Our technology and techniques have gotten very sophisticated which allows us to replace a joint with a much smaller incision, impacting far fewer internal structures, resulting in less post-operative pain and a faster return to normal activities,” said Dr. Vandit Sardana, a board-certified and fellowship-trained orthopedic surgeon at BMH.
Beaufort Memorial surgeons are also using “muscle-sparing” techniques, like the Direct Anterior Approach, to improve hip replacement outcomes. With the technique, the surgeon avoids having to cut and then reattach the key muscle group that enables you to walk and bend.
Same-day joint replacement
These new, more precise approaches help make it possible to replace some patients’ joints in the morning and discharge them the same day, getting them up and on their feet and on their way home where they can fully recover in comfort. While the majority of joint replacement patients at Beaufort Memorial have an overnight stay, currently up to 30 percent are discharged the same day.
“Moving from an inpatient to an outpatient surgery isn’t for everyone, but patients who are healthy and who have family and other support measures in place have the same outcomes as patients who stay in the hospital,” said Dr. Sardana, who sees patients at Beaufort Memorial Orthopaedic Specialists in Okatie and Port Royal.
In late 2020, the team created the Preoperative Assessment Clinic to thoroughly screen for any issue that may complicate the surgery and/or recovery. This allows providers to identify and remedy issues in advance, promoting patient safety and ensuring the best possible outcomes through a detailed workup and communication with the team.
“The Preoperative Assessment Clinic has no doubt contributed to our ability to move toward same-day joint replacements,” said BMH Joint Coordinator Andrea Sadler, PT. “The extra level of screening and intervention has increased the comfort level of the surgeons and the team in discharging patients more quickly.”
To support same-day joint replacement patients the hospital created a unique Bridge to Therapy program, easing the transition from the hospital to outpatient rehabilitation. Through the program, physical therapists visit patients at home several times during the first week of recovery. This important in-home rehabilitation, which is customized to individual needs, often streamlines the transition to outpatient therapy and gets patients quickly on the road to a more effective outcome with greater mobility.
“Joint replacement surgery has been moving in this direction for several years,” Dr. Sardana said. “Now we have the tools we need and the support services in place to make it a reality.”
Beaufort Memorial is one of only three hospitals in South Carolina to earn the Joint Commission’s advanced certification for total hip and knee replacement. This certification is a testament to the level of patient safety and quality of care provided by the surgeons and staff. For more information, visit BeaufortMemorial.org/Ortho.
