When Craig Della Valle, MD, chief of adult reconstructive surgery at Chicago-based Rush University Medical Center, calls his joint replacement patients the morning after surgery, the conversations are often surprisingly short.
They’re home. They’re walking. And most are doing exactly what they hoped they would be doing.
“I was driving in this morning calling patients I operated on yesterday,” Dr. Della Valle said during a fireside chat at Becker’s 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC Conference. “Five of the seven calls were, ‘Yeah, I’m doing fine.'”
For an orthopedic surgeon who has performed more than 14,000 joint replacements, those routine calls represent something extraordinary. Not because the operation has changed dramatically. Because everything around it has.
For decades, joint replacement was defined by hospitalization. Patients often spent several days recovering in a hospital bed before beginning rehabilitation. Today, most of Dr. Della Valle’s patients go home the same day. The transformation, he argued, has less to do with a single breakthrough than hundreds of smaller ones.
“We’ve gotten so much better with perioperative pain management and perioperative management in general,” he said.
The innovation often overlooked
Healthcare conversations often focus on new implants, robotics and surgical technology. Those innovations matter. But Dr. Della Valle believes the biggest gains in joint replacement have come from improving the details patients rarely see.
Anesthesia protocols. Pain management strategies. Blood-loss prevention. Recovery pathways. Discharge planning. Individually, none of those developments generated headlines. Together, they fundamentally changed what recovery looks like.
The result is one of the most significant shifts in modern orthopedics: moving joint replacement from the hospital into outpatient surgery centers. The idea was initially met with skepticism.
“The initial concern was, ‘You guys are nuts. This is not safe,'” Dr. Della Valle said. The concern was understandable. Hip and knee replacement had long been viewed as procedures that required hospitalization.
Then the data started accumulating.
As researchers studied outcomes across institutions and national databases, they found complication rates were not increasing in outpatient settings. In many cases, they were improving.
“Now we’ve really looked at the data, and it shows that the complication rate is actually lower when you have it at an outpatient facility,” he said. Today, 80% to 85% of procedures at his practice are outpatient.
The patients who surprise him most
One assumption continues to persist: Many people believe outpatient joint replacement is primarily for younger, healthier patients. Dr. Della Valle sees something different.
At a recent operating session, he performed outpatient procedures on three patients older than 80. All went home the same day. Age, he has found, is often less important than a factor more difficult to measure.
“The biggest thing that differentiates patients who are able to do outpatient surgery is patient personality,” he said.
Years of experience have taught him that recovery is influenced not only by medical conditions but by how patients respond to uncertainty, discomfort and stress. Some patients become anxious at the first sign of swelling or soreness. Others remain calm and confident throughout recovery.
Those differences matter.
“A lot of it is personality, because people who don’t handle stress or anxiety well, those are the people who are going to wind up in an emergency room,” he said. “I do not want my patients going to an emergency room.”
The hidden economics of surgery
As healthcare costs continue to rise, Dr. Della Valle said orthopedic surgeons need to pay closer attention to an uncomfortable reality. Many cost-saving opportunities are hiding in plain sight. Too often, discussions about efficiency focus exclusively on implants. In reality, dozens of smaller decisions influence the economics of every case.
The cement. The drapes. The gowns. The surgical packs. The disposable equipment opened in the operating room.
“I can save literally thousands of dollars on a case because I’m looking at every little step,” he said. The challenge, he argued, is that healthcare frequently assumes more expensive means better.
Orthopedics is no exception. One example is antibiotic-loaded bone cement, which can cost several times more than standard cement and is widely used in joint replacement surgery. Despite its popularity, Dr. Della Valle remains unconvinced the evidence justifies routine use in many primary procedures.
“There has never been and will never be a randomized controlled trial that suggests antibiotic cement is better than regular cement for knee replacements,” he said.
For him, the broader issue extends beyond any single product. Medicine often rewards novelty. Value requires skepticism.
Why culture still matters
As joint replacement has become increasingly efficient, Dr. Della Valle believes one factor remains consistently undervalued.
People. Successful outpatient surgery depends on far more than surgeons. Nurses. Technicians. Physical therapists. Schedulers. Recovery-room staff. The entire system has to function together.
Over the years, he has learned that culture often influences outcomes more than leaders realize.
“You say good morning to people. You learn their names. You treat them with respect,” he said. “They take better care of your patients.”
The observation may sound simple. Dr. Della Valle believes it is anything but.
Healthcare organizations spend enormous resources pursuing technology, expansion and operational improvement. Yet some of the most important drivers of performance remain remarkably human.
Trust. Respect. Teamwork.
Those qualities do not appear on financial statements. Yet they are often the difference between good organizations and exceptional ones.
What value actually means
Few terms appear more frequently in healthcare than value. Few are defined less clearly. For Dr. Della Valle, value is not about spending less money. Nor is it about denying patients access to care.
It is about understanding which interventions actually improve outcomes.
“We did a study looking at what nonoperative treatments patients received before hip and knee replacement and which ones they thought were most helpful,” he said.
The findings challenged conventional assumptions.
“We found that things like anti-inflammatory medications and Tylenol were among the things patients thought helped them the most,” Dr. Della Valle said. “There is this sense that it has to be expensive to work. I really don’t think that’s the case.”
After more than two decades in practice, he remains convinced that progress often comes not from doing more, but from understanding what truly matters.
The biggest breakthroughs in joint replacement, he said, were never the flashy ones.
They were the countless improvements that made recovery safer, faster and more predictable for patients. And most of them happened long before the surgeon picked up a scalpel.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
