Dr. Mark McFarland: The Future of Total Joint Replacement as an Outpatient Procedure

Written by Laura Dyrda | August 16, 2010 | Print  |
Mark McFarland, MD, a physician with Orthopaedic & Spine Center in Newport News, Va., performed the first outpatient total hip replacement in Virginia. He performed this procedure just weeks after his colleague Boyd Haynes, MD, performed the first outpatient total knee replacement in Virginia. These procedures coincide with what Dr. McFarland considers the current trend in orthopedic surgery: outpatient, minimally invasive procedures.

Dr. McFarland's outpatient total hip replacement
For this procedure, Dr. McFarland implanted the hip replacement through an incision in the front of the hip as opposed to the posterior approach. The surgery did not require cutting any of the major hip or buttocks muscles.

"I used one of the new direct anterior muscle sparing hip replacements. There's very minimal blood loss and bleeding in the post-operative period," says Dr. McFarland. "The patients are typically able to progress pretty rapidly from the post-operative room."

Eight hours after completing the procedure, Dr. McFarland's 63-year-old patient was able to return home. Once there, a home healthcare system provided the patient with additional support. The home health team as well as a physical therapist visited the patient twice per day for the first four days, administering the same care the patients would receive in the hospital.

"It's almost as if you've taken the patient's hospital room and put it in their home," says Dr. McFarland. "The patient is doing extremely well."

New technologies
Several new technologies make total joint replacement surgery possible as an outpatient procedure. The anterior hip replacement requires a custom bed which allows the surgeon to manipulate it, placing the patient in the best position to receive a smaller incision. Modern implants are also available to accommodate the minimally invasive surgery.

"The procedure itself has become much less invasive, but I don't think that by simply performing the minimally invasive procedure patients are going to be able to go home," says Dr. McFarland. Developments in anesthesia, home healthcare services and electronic communication play significant roles in sending total joint replacement patients home within 24 hours.

Before the total hip replacement, Dr. McFarland administered a low dose of spinal anesthetic and additional light anesthesia to the patient. Patients who receive light anesthesia become lucid sooner after surgery which means they can begin physical therapy right away.

"The quicker the patient is able to begin physical therapy, the quicker they're going to be able to go home," says Dr. McFarland.

Dr. McFarland says patients undergoing total knee replacement surgery receive anesthesia pumps instead of requiring IV pain medication. Patients take the pumps home with them for administering further pain relief.

Finally, computers have made a big difference in physician/patient communication from home.

"My patient is sending me e-mail updates every day and pictures of the incisions. With today's technology we're able to keep up with the patients," says Dr. McFarland.

Advantage of outpatient procedures

"By performing outpatient total joint replacements, you will save a lot of money for the healthcare system," says Dr. McFarland. "The less time the patient spends in the hospital, the less out-of-pocket expense it is for them, depending on the payor. This type of surgery is also good for the insurance company because if the patient goes home early, the payor can cut reimbursement to the hospitals."

Outpatient procedures save money for the patient and payor because the patient is spending less time in the hospital and consuming less of the hospital's resources. Total joint replacements could also move to ASCs as an outpatient procedure.

"If you look at every aspect in joint replacement and sports medicine, everything is going toward minimally invasive procedures," says Dr. McFarland. "I think you're going to see a significant trend of procedures done at ASCs instead of hospitals."

However, performing total joint replacements as outpatient procedures can also be advantageous for the hospitals. The patients spend less time in their hospital bed which opens space for more patients and procedures. Though the patient's length-of-stay decreases, the volume of patients has the potential to increase.

"You have to prove to the hospitals and the insurance companies that the procedure can be done on an outpatient bases and they both can have great results," says Dr. McFarland.

Learn more about Orthopaedic & Spine Center in Newport News, Va.

Read other coverage on minimally-invasive surgeries:

- Surgeon Analysis: Outpatient Lumbar Discectomy has Excellent Results, is Safe and Low Cost at ASCs


- Dr. Boyd Haynes: Q&A About Virginia's First Outpatient Total Knee Replacement

- Ellipse Technologies Complete Positive Trials for MAGEC Remote Control for Childhood Scoliosis



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