People frequently ask me what has changed lately in the world of hip and knee replacement surgery. They are usually referring to how the implants have changed or if the longevity of implants has improved. Actually, over the last 5 years in the field of hip and knee replacement surgery the biggest and most exciting change has been in the location of the surgery itself. Since the advent of joint replacment in the 1970s, these surgeries have traditionally been performed in hospitals. For many years this was the only viable option as the surgeries originally took several hours to perform and the rehabilitation and pain management protocols were completly overlooked and given very little emphasis. During that time the emphasis was put on figuring out how to successfully perform the cases - how you did as a patient after the surgery including the pain you were in or how long you stayed in a hospital was given no emphasis and assumed to be of little clinical importance.

In the early 2000s, our industry began to talk about minimally invasive surgeries, especially regarding hip replacement - at that time the era of patient satisfaction and interest in quality of recovery experience were born. We began to question all of our assumptions about these cases. We found that people did not have to stay in the hospital for 10 days to 2 weeks. We found people could go from the hospital to their homes and not to a skilled nursing facility for weeks after discharge. People began to stay in the hospital for just 3 days after the surgery. In 2003, that was considered a huge leap forward. We then began to realize that how a patient experienced their recovery, particularly how well their pain was controlled and how quickly they moblilized, had a huge impact on their complete recovery and long term satisfaction with their hip or knee replacement.

At this point, we made huge advancements in pain management. We realized as an industry that narcotic pain medication, while necessary to a degree during recovery, was not benign and was not a good management tool for pain control when used alone. The concept of multi-modal pain management began to take hold. In this model, we understand that the brain receives, interprets, and experiences pain on multiple levels and in complex ways. Narcotic pain medication only addresses a portion of this system of pain. When we began applying this understanding of post surgical pain control to hip and knee replacement surgeries, an amazing synergy developed between this new method of pain control, physcial therapy, and patient participation. People were waking up from surgery without severe pain. They were able to immediately mobilize. They were not suffering from debilitating nausea, vomiting and dizziness (very common previously). They could eat full meals within hours of surgery and they did not need to be hooked up to IV poles or urinary catheters. They could feel and use their extremities. Soon patients were leaving the hospital routinely the morning after their surgeries. Not long after that we realized they could go home the same day and recover from the comfort and security of their own home and avoid staying even over night at the hospital.

The next logical progression in this paradigm shift was to question why these procedures even had to be done in the hospital at all. We knew that for years many orthopedic surgeries were done away from hospitals with great success - shoulder rotator cuff repairs, knee ligament repairs, most hand surgeries, many types of fracture repair. Moving these surgeries to outpatient surgery centers benefited the patients and the surgeons. We now realized we could move hip and knee replacemnt into the same space - outpatient surgery centers. The benefits were obvious. Avoiding the hospital - buildlings built to care for the sick - made perfect sense. Hip and knee replacement patients are not sick. They are healthy people that need a skilled care team and excellent surgical facilities. So, in 2014, I performed the first outpatient hip repalacement from a surgery center ever done in the Northwestern United States and it was a huge success. This was followed by 100 other hip and knee replacement procedures. We knew this model could now apply to many surgical areas including many spine surgeries and trauma procedures. However we needed a facility built for this purpose and dedicated to these types of cases. Up to this point, surgery centers had been built to take care of smaller cases - none had the facilities we needed to apply this model fully. This is when Oregon Surgical Institute in Beaverton, Oregon was born. We collected a group of 13 of Oregon's finest joint replacement, sport, hand, spine, and trauma surgeons and built a first of its kind, state of the art facility. There is no other facitlity like it in the Western United States. It opened in April of 2018 and became fully operational that summer. We have now done hundreds of hip and knee replacement surgeries along with spine, sports, hand and trauma cases. It is a center of excellence unique in its size, development, vision, and mission. Orthopedic surgery is moving, as it should, away from the limited and complex hospital environment into the nimble and streamlined outpatient center world and OSI will lead that move. I am proud and excited to have been a founder of this outstanding institution and am even more excited to offer this location to my patients for their hip and knee replacement procedures.

Oregon Surgical Institute