1 2 S U P P L E M E N T T O 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 A U G U S T 2 0 1 6
many ways the procedure resembles total knee surgery," says Dr. Nilssen. He
employs an anterior approach by making a lateral incision down the middle
of the ankle, much like he would during a fusion procedure. Once the ankle
joint is exposed, he uses alignment and cutting guides to determine how
much bone to resect on the distal tibia and the proximal talus before making
the cuts. The implants are placed and fixated by bone ingrowth. The ankle is
splinted after surgery and patients must avoid putting weight on the joint for
4 to 6 weeks.
Dr. Nilssen's staff calls private insurers before cases to get authorization
for the procedures. The center works out the co-pays and confirms payment
amounts for the needed implants, which typically cost between $10,000 and
$12,000 — that's much more expensive than the hardware used in total
knees and total hips.
With the profit potential and patients benefiting from longer-lasting implants
that preserve the range of motion in the ankle and reduce wear and tear on the
joints in the foot, Dr. Nilssen believes efforts to move total ankles to the outpa-
tient setting will resemble the evolution that has taken place with hip and knee
replacements.
Shouldering the load
Chris O'Grady, MD, a shoulder specialist at Andrews ASC, says the typical
patient suffers from end-stage glenohumeral osteoarthritis, although his
patients span the spectrum of older individuals with worn-out shoulder joints
to young, active adults with degenerative joints caused by previous injury.
Like Dr. Nilssen, his ability to bring more patients to the surgery center is
limited only by Medicare. He points out that performing shoulder replace-
ments in the outpatient setting is inherently less problematic than managing
the logistics of ambulation and fall risks for total hip and knee patients. "My
patients walk out of the hospital on post-op day 1 with a smile on their face,"
he explains. "They might as well walk out of the ASC on the day of surgery
with the same smiles."
