Presidio Outpatient Total Joint Program
population for joint replacements is getting younger. Patients are interested
in getting home as soon as possible, and returning to as high an activity level
One of the
biggest postoperative challenges for patients undergoing total knee or hip
replacements is pain. Historically, pain has kept patients in the hospital on
an average of two to three days. Pain limits patients ability to participate in
physical therapy, and has led to longer hospital stays.
Mayle, of California Pacific Orthopedic and Sports Medicine, has developed a comprehensive
protocol that allows motivated patients to have their total hip or knee
replacement done in an outpatient setting and go home the following morning.
combination of minimally invasive surgical techniques, regional anesthesia, and
a state of the art facility, the patients are able to get out of bed
and participate with physical therapy hours after their surgeries.
patients have extremely high satisfaction with the rapid recovery protocol. It’s better for the patient to go home as soon
as possible. The hospital environment can be counterproductive for healing. Hospital
acquired infections are a reality, and the longer a patient stays in the
hospital environment, the higher the chance is for a post-operative infection. Moreover,
complications such as blood clots are lessened if patients are allowed to get
out bed and walk.
anesthetic techniques have revolutionized hip and knee replacement. Patients
receive a regional anesthetic, similar to a local anesthetic, and then are
placed into a twilight sleep. This allows patients to avoid undergoing a
general anesthesia and lessens complications such as post-operative nausea,
vomiting, and confusion. “Immediately after surgery, our patients are awake,
alert and ready to participate in physical therapy”. Says Mayle. Mayle also
uses a time-released local anesthetic that lasts 48 hours, the time period
where patients’ pain is most intense. There is an emphasis on using non-narcotic
pain relievers like intravenous anti-inflammatories and Tylenol. “Intravenous
narcotics are counter-productive to recovery. They will lower blood pressure,
increase nausea/vomiting, lessen the desire to get out bed, are constipating,
and slow the recovery process”.
Mayle uses advanced
minimally invasive surgical techniques, where he focuses on accurate
reconstruction of the joint. All incisions are closed with absorbable sutures,
so there are no staples
or sutures to remove. The wound is covered with a silver impregnated occlusive
dressing that protects against infection and allows
patients to shower immediately after surgery. Patients are healing faster and Dr. Mayle is
seeing them at two weeks out of surgery at a level of mobility that usually
took three months for both hip and knee replacements.
receive outpatient physical therapy usually starting in their home and then
transition to outpatient physical therapy in 1-2 weeks.
“For us, we
are not interested in just doing surgery. We are interested in the complete
care of the patient from surgery through recovery,” says Dr. Mayle. “My
patients that have undergone rapid recovery total joint replacement are
routinely more satisfied than those that have undergone traditional joint
replacement. As one patient said, ‘why would anyone do it differently?’”.
patient is a candidate for ambulatory surgery. It depends on the home situation
and other underlying medical problems. For a consultation to see if you would
qualify for our program, please contact Dr. Robert Mayle at 415-668-8010.