surgeons need to understand and commit to an approach that pre-
pares patients for same-day discharge. They need to implement blood-
conserving techniques and operate efficiently to shorten the amount
of time patients are anesthetized.
Surgeons must also use instrumentation designed to minimize mus-
cle and tissue damage in the joint. "I use low-profile instruments and
avoid pulling on or tearing muscle," says Dr. Shah, "I also focus on
limiting how much tissue I grasp or pinch."
Dr. Haas has developed a surgical technique that involves operating
through small incisions and eliminates the need to cut the quadriceps
tendon, factors that limit post-op pain and help to prepare patients for
same-day discharge.
He also points to the tremendous strides orthopedic device manufac-
turers have made in the design and availability of numerous implants
that are better anatomical fits for a variety of patients. Anatomically
correct femoral and tibial components improve the post-op alignment
of the knee, distribute load-bearing forces more evenly and share the
stress and pressure placed on the joint with the patient's natural liga-
ments and tendons. These factors maximize joint mobility and func-
tion after surgery.
Running an efficient and successful outpatient total joints program
requires building a group of hard-working professionals who work
toward a common goal and are driven to achieve excellent outcomes,
according to Dr. Shah.
Members of the nursing staff must understand the importance of
direct and detailed communication with patients, and sterile pro-
cessing professionals must oversee the management, sterilization
and storage of large and complex instrument sets. Clinical leaders
need to make sure patients move along the clinical pathway effi-
ciently and safely. Facility administrators must manage staffing lev-
4 6 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 2 0
