Same-day joint replacement at NYU Langone Hospital-Brooklyn — 5 keys to success

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Hip and knee reconstruction specialist Joshua Rozell, MD, helped pioneer same-day joint replacement surgeries at NYU Langone Hospital-Brooklyn. For his team, careful patient selection and surgical planning have been key to quality outcomes.

Five elements of same-day TJR program success, according to Dr. Rozell:

1. Setting expectations. Dr. Rozell takes a holistic approach that begins with comprehensive preoperative patient education on the procedure and how to prepare. A clinical coordinator discusses discharge plans with patients preoperatively and arranges home therapy.

 "I set these expectations from the first visit through postoperative care so patients understand what's ahead," Dr. Rozell said. "If the patient isn't educated about rehabilitation, the recovery timeline and potential postsurgical issues, they are more likely to return to the emergency department or be readmitted after surgery."

2. Care team coordination. It's essential to ensure that everyone from nursing and operating room staff to the anesthesiologist, surgeon and physical therapist are working in tandem toward quality outcomes, Dr. Rozell said.

3. Optimizing techniques. Dr. Rozell uses the anterior approach for most total hip arthroplasty procedures. For knee surgery, Dr. Rozell uses computer navigation to improve knee alignment and postoperative range of motion. He also avoids using a tourniquet to reduce the risk of muscle dysfunction after knee replacement, and facilitates early patient mobilization with the use of a short-acting spinal anesthetic.

"Without a tourniquet, blood continues to flow through the musculature of the leg, the quadriceps may return to normal functionality faster, and we tend to see fewer nerve-related problems," he said.

4. Careful patient selection. Dr. Rozell considers how healthy patients are, how motivated they will be after surgery, their activity level and what social supports they have in place when determining whether they are suited for same-day discharge. Patients who live alone, have language barriers or lack insurance access may have difficulty adhering to postsurgical protocols and completing physical therapy.

5. Supporting discharge. With the help of Manuel Wilfred, PhD, assistant supervisor at Rusk Rehabilitation at NYU Langone Hospital-Brooklyn, Dr. Rozell has patients mobilized in as little as 90 minutes after they leave the operating room. Patients first sit up, get out of bed and begin walking. Later, stairs are incorporated to ensure the patient can safely return home and begin physical therapy the next day.

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