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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Outpatient Total Joint Replacements? PT is Key

Published February 4, 2014 1:37 PM by Jon Bassett
LAS VEGAS, NV -- In western Pennsylvania, an enterprising group of physicians is performing total knee and hip replacements in a select number of outpatients, and sending them home just hours after the procedure.
How does PT fit into the picture? This game-changing protocol relies on a hefty dose of skilled nursing and physical therapy involvement to be successful.
“This is an exciting topic, and without therapists this doesn’t happen,” related Christopher McClellan, DO, orthopedic surgeon and partner in University Orthopedic Center, a five-physician practice in Altoona, Pa. McClellan, who’s been in practice for 9 years and specializes in total joint procedures, delivered the presentation “Same-Day Outpatient Total Joint Replacement and Treatment” along with Dan Casillo, MPT, at the APTA’s Combined Sections Meeting Tuesday morning Feb. 4.
A nurse and physical therapist are waiting for the patient at home following discharge from the ambulatory surgical center just hours after the procedure, said Casillo, who went on to outline the specialized rehab that follows -- which involves more acute-care responsibilities in the first few days.
McClellan told his audience of mostly home care therapists that the idea came to him after realizing that many of the patients in the hospital after total joint arthroplasty did not need to be there, and would have rather been home.
“It’s just a change in thinking,” he said. “Thirty years ago you couldn’t walk on [a replaced joint.] That changed.” Moving to this new paradigm will require a similar willingness to challenge established protocols.
The program is not for everyone – patients are carefully screened for health status, BMI, home and family support, and other variables critical for success. And Medicare has yet to come on board – the 85 patients that have undergone the protocol to date have all been private-insured.
But once word begins to spread, and greater numbers of surgeons, therapists and insurers realize the cost savings, the safety to the patient (McClellan stressed negligible readmission and ER rates, along with reduced incidence of hospital-acquired infections), and most of all, improved patient satisfaction and scores, outpatient total joint procedures figure to be the wave of the future in medicine.
“This is accountable care at its highest level,” said McClellan. “Isn’t this the goal of health care?”
Look for more details surrounding this program in our next cover story.

posted by Jon Bassett


I did not attend CSM this year, but I find this to be a very interesting topic. After working at a sports PT clinic for my last clinical rotation (I am a 3rd year DPT student), I believe that this concept would be great for patients who are very active or trying to get back to playing sports after a total joint arthroplasty. I agree that this would be a great way to reduce health care costs, as we all know that staying in the hospital is expensive. Also, patients tend to feel better when they are living at home with all the familiarity of their personal items and the support of family during their recovery process. For those with few co-morbidities and good general health status, I agree that same-day outpatient treatment would be appropriate and effective. The sooner patients can learn how to move and perform their daily routine at home within their post-op restrictions, the better the patient's quality of life will be. They will sleep better, be more relaxed, and hopefully more compliant with their post-op restrictions and physical therapy home program. It is exciting to hear about our involvement as PTs in facilitating a faster and more effective recovery after total joint replacement procedures. Thank you for sharing!

Lindsey April 9, 2014 10:39 AM
Greenville NC

Interesting and exciting stuff.

Dean Metz February 4, 2014 2:33 PM

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