Total Joints Implementation and Operation of a Joint Replacement
Program in an ASC
Total Joints Implementation and Operation of a Joint Replacement
Program in an ASC
John Dunleavy, MDMatt Searles, Merritt HealthcareBill Mulhall,
Merritt HealthcareKerri Ubaldi, Merritt HealthcareMatt Kilton,
Eveia Health Consulting
OCTOBER 15, 2015
ObjectivesBenefits & Challenges with Joint Replacement in
the ASC
Joint Replacement Overview
Operative considerations
Staff training
Clinical requirements to consider
Current reimbursement considerations and hurdles
Challenges of Joint Replacement in an ASC Pain Control Physical
Therapy Previous potential need for blood transfusion Reimbursement
Getting the patient onboard
Benefits of Joint Replacement in an ASC The ASC is a highly
specialized and controlled environment Less rigid and more
costeffective setting than that of a hospital Patient satisfaction
is higher Significantly lower infection rates Advances in surgical
technique, implants, comprehensive blood management, and pain
management have eliminated the need for an overnight hospital
stay
Joint Replacement OverviewPartial Knee Replacement-Concept:
Resurface only symptomatic area-Even if some wear exists
elsewhere-Increasing in popularity-Less surgery than TKA-No
ligaments removed = knee feels more like a normal knee
Three Compartments of Knee
May Resurface Any or All Compartments
Total knee replacementDegenerative kneeCutsImplant
componentsImplanted
Total Knee ReplacementWith TKA, the damaged knee surfaces will
be resurfaced with metal and plastic implants.
The selected implants are sized to the patients
specifications.
Recent AdvancesPatient-specific TKAPre-op 3D imaging used to
reverse engineer unique cutting guidesAllows surgery through
smaller incisionLess surgical trauma = less pain / quicker
recovery
Minimally Invasive Technique
Robotic SurgeryTechnology here to stayAllows more accuracy
Importance unclear
Makoplasty
Blue Belt
Makoplasty
TOTAL HIP REPLACEMENT
HIP ANATOMY:
Socket
Ball
Femoral neck
Smooth weight-bearing surfaces
Smooth cartilage
FemurSurgery - Total Hip Replacement
Cuts
Implant components
ImplantedAnterior ApproachIncreasingly popularNo muscle
detachmentImproved immediate post-op functionNo post-op hip
precautionsMay use x-ray during surgeryNot for everyone
Posterior ApproachStill most commonIncision length greatly
reducedSome muscles detached from femur boneHistorically higher
risk of dislocationHip precautions
Staff Training & Preparation Physician and staff meetings to
evaluate needs (anesthesia involvement is key)
Good understanding of supplies and equipment required
Obtain written policies and protocols, physician orders
Consider sending staff to an ASC that currently does total
joints to observe
Mock total joint procedure
Partnering with VNA / Rehab Establish what your needs are &
what they can provide
Determine postoperative physician orders for nursing &
PT
Determine timelines for visits the day of the procedure
Transfer of physical therapy back to the physician practice if
necessary
Patient SelectionNon-smokerNo diabeticsNo bleeding disorders or
anticoagulant therapyNo liver diseaseBMI parameters to be
determined recommending BMI
