his anesthesia begins to wear off. The nurse helps the patient get in
and out of chairs, walk across a flat surface, and walk up and down a
flight of stairs. The exercises together last for about 40 minutes, after
which nurses contact the home nursing agency and prepare to send
the patient home for surgery — all within a few hours of them arriving.
2
Plan out the procedure
You can make sure your total hip operation is far more efficient
by planning out a roadmap of the procedure. Our facility does
this with the help of orthopedic digital templating. We take the stan-
dard X-ray of our patient's hip and put it into our templating computer
program. The program comes with all sizes of implants already in its
system, letting us fit an implant against a picture of the X-ray to decide
on the general size of the implant. It also lets us visualize where to
make our cuts and determine the anteversion and abduction of the
acetabular component of the implant.
Using digital templating to estimate implant size can be remarkably
accurate. A 2016 study that used digital radiographs to retroactively
template total hip replacements found that the digital system predict-
ed the accurate prosthesis within 1 cup size in 96.6% of cases and
within 1 stem size in 97.8% of cases.
I often hear from surgeons who want to take an X-ray in a surgery
center but that it's difficult to organize because of space. You need an
F E B R U A R U Y 2 0 1 8 • O U T PA T I E N TS U R G E R Y. N E T • 8 7
I advise facilities to focus on doing the type of surgery that's
most comfortable for their surgeons and most feasible in terms of
cost and space. For us, that's posterior. We've found that it's easi-
er, quicker and more cost-effective. The anterior position requires
a specialty table that can cost as much as $150,000.
— Christopher McClellan, MD
