Outpatient hip replacements: under certain conditions

Edito of 10/31/2014

The relaxing of administrative rules and advances in minimally-invasive technology look set to make it possible to give patients a hip replacement in the morning and discharge them in the evening. But early discharge is only possible under certain conditions.

Outpatient hip replacements are, it seems, are on everyone’s lips. When we did a Google search for “hip replacement” in early October 2014; the first lines featured two news items from regional newspapers in France. The first, published in Le Courrier Picard on 30 September, carried the title: “get a hip replacement in the morning and get back on your feet the same evening”. The second, in La Voix du Nord, on 28 September, indirectly mentions hips: “after a hip operation in May, last week the Cambrésis clinic this time successfully performed an outpatient knee replacement”.

At the source of this “media breakthrough” is the relaxing, in March 2014, of the requirement to keep hip replacement patients in hospital for at least four nights after the operation. Before the law was relaxed, clinics and hospitals risked a heavy fine if they discharged a patient too early.

Now that the administrative requirements have been relaxed, doctors just needed the surgical technology to make outpatient hip replacements a reality. The solution came in the form of minimally-invasive techology. Less traumatising and painful than normal surgery, this technology make post-operative follow-up simpler and an early discharge possible, depending on the patient’s state of health.

Minimally-invasive hip surgery, pioneered by French surgeons, is characterised primarily by small incisions. Accessing the joint using the anterior Hueter approach has a minimal impact on anatomical elements, particularly the muscles and the periarticular region. The muscles are simply moved aside and the tissue left undisturbed.

Outpatient hip replacements are, however, unlikely to become the norm. They will be mainly used for young patients living close to the health facility, with good muscle tone and without comorbidities In reality, the relaxing of administrative requirements and the emergence of minimally-invasive hip surgery has given surgeons the freedom to decide what’s best for the patient on whom they have just operated - two, three or four days in hospital, or a same-day discharge. In addition, it is important to point out that it still compulsory to keep someone who has received an operation in hospital (for six days) if they are aged over 80 or if the operation concerned the revision of an existing prosthesis.

Arthrolink Editorial Committee