A Knee, Hip or Shoulder Replacement To Go

By Dr. Vladimir Alexander

When retired NHL goaltender Olie Kolzig underwent hip surgery a few years after his 14-year professional hockey career ended, I planned something unusual for his recovery.

“They were trying a different approach,” says Kolzig, 45, who played nearly his entire career with the Washington Capitals. “They felt the hospital wasn’t the best place for my recovery, so they set up a hotel room with a hospital bed.”

It’s a philosophy that I, as an orthopedic surgeon (www.alexanderorthopaedics.com) continue to promote. I’m a pioneer in the effort to allow patients who undergo total-joint arthroplasty to spend their recovery away from the antiseptic walls of a hospital.

While with Kolzig that meant a hotel room, for most of my patients it involves heading home after surgery to recover in familiar surroundings, aided by family and home healthcare professionals.

It takes away a lot of the nervousness about being in a hospital that so many people have. People are more comfortable and recover better when they are in their own homes.

There are other advantages to handling these knee, hip and shoulder surgeries – which I perform in my practice’s own surgical center – on an outpatient basis.

We have helped eliminate over and under medication by hospital nurses, and have lessened the risk of infection.

Total-joint arthroplasty is the surgical replacement of a joint or joint surface with artificial materials, such as metal and high-density plastic. Kolzig, for example, suffered a degeneration of his hip that became worse and worse until bone was scraping against bone.

The procedure he underwent is called a Birmingham hip resurfacing. Unlike a total hip replacement, where the bone in the ball-and-socket hip joint is removed, just a few centimeters of the bone are resurfaced.

Traditionally, total-joint arthroplasty requires a three to four-day hospital stay where the patient is managed medically and orthopedically while they recover from the surgery.

But I believe that hospital stay isn’t necessary – or even desirable – for many patients, which is why I began offering the surgeries on an outpatient basis five years ago, making ,e one of a handful of surgeons doing that nationally.

This especially appeals to patients who are in their 40s and 50s and need joint replacement sooner than they expected. Probably 60 percent of my patients are middle-aged, weekend athletes.

Not all patients are ideal to have their surgical recovery handled on an outpatient basis. The best candidates are:

• Younger than 65
• Healthy and mobile
• Have a good support system at home

I envision this approach as the wave of the future in orthopedics. In five to 10 years, outpatient will be part of the normal discussion when doing a consultation on joint replacement. It is a better technique and a safer technique. And I think there is just this peace of mind from the patients’ point of view when they know they will go home immediately and spend their recovery time in comfortable surroundings.

Olie Kolzig is certainly happy with the success of his procedure. As a player development coach with the Capitals, he still takes to the ice regularly to work out with younger athletes.

He also golfs and paddle boards.

There is nothing I do that is ever impeded by my hip,” Kolzig says. “No limitations. No aching. No twinges. Nothing like that. The only negative is I set off the metal detector when I go to the airport.”

Dr. Vladimir Alexander is an orthopedic surgeon and founder of Alexander Orthopaedic Associates (www.alexanderorthopaedics.com), which offers patients the latest in cutting-edge technology and new advances in orthopedic surgery and care. He specializes in disorders of the shoulder, hip and knee, including total-joint arthroplasty and Birmingham hip resurfacing. Dr. Alexander earned his undergraduate degree at The John Carroll University in Ohio and his medical degree at The Ohio State University College of Medicine.