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, hip or shoulder
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.
Presidio Surgery Center has developed a comprehensive
protocol that allows motivated patients to have their total hip, knee or shoulder
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, knee and shoulder 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. Presidio 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.
Presidio's credentialed surgeons use advanced
minimally invasive surgical techniques, where they focuse on accurate
reconstruction of the joint. All incisions are closed with absorbable sutures,
so there are no
or sutures to remove.
Patients are healing faster and their surgeons are
seeing them at two weeks out of surgery at a level of mobility that usually
took three months for both hip and knee replacements.
Hip and Knee patients
receive outpatient physical therapy usually starting in their home and then
transition to outpatient physical therapy in 1-2 weeks.
not interested in just doing surgery. We are interested in the complete
care of the patient from surgery through recovery. Our 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 one of our program physicians.
Dr Rob Mayle (hips and knees) - 415-668-8010
Dr Peter Callander (hips and knees) - 415-668-8010
Dr Chris Cox (hips and knees) - 415-668-8010
Dr Jon Dickinson (knees) - 415-668-8010
Dr. John Belzer (shoulders and knees) - 415-668-8010
Dr Jim Kelly (shoulders) - 415-392-3225
Dr Tom R. Norris
(shoulders) - 415-392-3225
Dr. Kevin Louie (knees) - 415-600-3835
Dr Gordon Lundy (knees and hips) 415-923-3015
1635 Divisadero Street, Suite 200
San Francisco, CA 94115