OUTPATIENT HIP AND KNEE REPLACEMENT
In a typical hip or knee replacement surgery, a surgeon makes a 12-inch incision cutting muscle, tendon and bone. A patient spends three or four days in the hospital, then it’s a month before they can drive and three months before they can go back to work.
But hip and knee replacements with Dr. Richard Berger, orthopaedic surgeon at Midwest Orthopaedics at Rush and assistant professor of orthopaedics at Rush University Medical Center, are anything but typical.
A pioneer of minimally invasive joint replacement surgery, Dr. Berger performs surgeries on an outpatient basis. A few hours after they emerge from the operating room, his patients typically walk 200 feet around the nurse’s station, climb up and down a flight of 15 stairs, and then go home the same day.
Normally, surgeons cut muscles and tendons, and the joint is dislocated. There are a lot of functional restrictions, and the patients have a great deal of pain. Then, because they’re afraid of the pain, they’re apprehensive about moving their leg in physical therapy.
What Dr. Berger does is drastically different.
With his minimally invasive approach to knee surgery, Berger makes a small 3- to 4-inch incision, without cutting through muscles, tendons and ligaments, so patients can recover faster. The recovery time is shorter, which enables patients to move their leg as quickly as possible before scar tissue builds up.
Dr. Berger has used his mechanical engineering background to develop surgical tools that enable him to maneuver around a patient’s muscles and tendons to reach the arthritic bone. Then he carefully removes small pieces of the bone until he gradually has enough space to implant the new prosthesis, which is the same type of prosthetic used in standard total joint replacements.
Subsequently, instead of being in the hospital for four to five days, our patients are in the hospital for four to five hours. Instead of being able to drive in two months, they’re able to drive in a week. Instead of being able to go back to work in three months, they are off work for a week or less.
The speed of recovery has another benefit.
The short recovery time makes the surgery accessible for more patients, who might not be able to take three months off work. Many people who would benefit from hip or knee replacement surgery never get the operation and instead live with the pain and reduced functioning.
Knee replacement patients have almost no functional restrictions post-surgery, as long as they listen to their body. We tell patients to do whatever they want to do on the first day. For driving, if after a week if you feel good, go for it.
Hip replacement patients have a few more cautions during the recovery period — such as not bending more than 90 degrees — to avoid any risk of dislocation, but after that some patients are back to doing yoga and other activities within three weeks.
Both knee and hip patients have in-home physical therapy for one week, followed by four to six weeks of outpatient physical therapy. We stress preemptive pain and nausea control, giving patients a detailed medication schedule. Two to three weeks before surgery, patients take a two-hour preoperative education class so they know exactly what to expect.
With Dr. Berger’s minimally invasive approach, patients have less time in the hospital and are able to regain motion much more quickly.