matory drug (NSAID), acetaminophen, an anti-anxiety medication and
oxycodone. We give dexamethasone intraoperatively to help control
pain and prevent nausea. We usually discontinue opioids by the first
follow-up visit at 2 weeks post-op.
Some studies suggest that the anterior approach might result in
more blood loss than the posterior approach, but I think that's
dependent on the experience of the surgeon. I've done more than 500
hip replacements with the anterior approach in the outpatient setting,
and have had to transfer only 1 patient to the hospital on the day after
surgery because of symptomatic blood loss and anemia.
We do a couple of things to minimize the risk that patients will have
asymptomatic anemia post-operatively. First, if patients are anemic
pre-operatively, we determine why they are and consider ways to cor-
rect it, such as by giving them iron supplements. They might also have
an occult GI bleed that needs to be treated. Second, we give oral
tranexamic acid, a medicine that helps with clotting, to all patients
before surgery. Spinal anesthesia also lets us maintain a lower blood
pressure, which results in less bleeding. We also use hemostatic
devices to help minimize blood loss.
No looking back
In our 5-year experience with anterior-approach total hip replacement,
we've had low complication rates, high patient satisfaction and signifi-
cant cost savings. If your surgeons and your facility are properly pre-
pared and your patients carefully selected, outpatient total hips are a
win for everyone involved.
OSM
A U G U S T 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 2 3
Dr. Toy (ptoy@campbellclinic.com) specializes in joint replacement and sports
medicine at Campbell Clinic Orthopaedics in Memphis, Tenn.
