David William Fabi, MD - Joint Replacement Specialist Appointment Image
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Out Patient Joint Replacement Surgery
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Meet Dr. David Fabi
Orthopaedic Surgeon
Providing patient care is a blessing and is not a privilege I take for granted. I pride myself on doing all I can to...
David William Fabi, MD - Joint Replacement Specialist

Services

Outpatient Minimally Invasive Joint Replacement

Outpatient joint replacement is a surgery that does not require an overnight hospital stay. Joint replacement is a surgical procedure in which the worn, damaged surfaces of the joint are removed and replaced with new artificial parts.  Your doctor may consider joint replacement if you have severe pain which limits daily activities and is not relieved with medications, injections, physical therapy, or other treatments. The goal of the surgery is to relieve pain and restore the alignment and function of your joint.

Traditionally, joint replacement has been an inpatient surgical procedure. With the introduction of minimally invasive techniques, modern pain protocols, improved anesthetic techniques, and rapid rehabilitation protocols surgeons are able to perform joint replacement procedures on an outpatient basis. Outpatient joint replacement is exactly the same as traditional joint replacement but the patient is allowed to go home in the first 24 hours after the surgery. This allows patients to recover at home instead of overnight in a hospital. A nurse in the patient’s home closely monitors the patient’s condition and checks vital signs  the same as what is generally performed at the hospital. Physical therapists are also available for in- home patient visits for several days to work with the patient on range of motion and flexibility exercises.

Not everyone requires or qualifies for outpatient joint replacement. However, for selected patients, outpatient joint replacement surgery is a reality. To be considered for an outpatient joint replacement, a person should have good health (free of any diseases), a high level of motivation during the rehabilitation process, and good family support.

Benefits:

The benefits of outpatient joint replacement over inpatient traditional joint replacement include the following:

  • Decreased hospital stay
  • Improved pain management protocols
  • Early mobilization
  • Careful home monitoring
  • Fewer complications
  • Improved outcomes
  • Increased patient satisfaction

With outpatient joint replacement surgery, patients are discharged from the hospital to the comfort of their own home following surgery and are provided with the support of an in-home nurse and follow-up rehabilitation services.  Patients can often return to normal activities quicker and with less pain than with traditional joint replacement surgery.


Robotic Assisted Joint Replacement

A minimally invasive and cosmetic total hip and knee arthroplasty is a newer approach to hip and knee replacement. The surgical technique and artificial implants remain the same as traditional joint arthroplasty. The difference is that surgery is performed through one or two smaller incisions rather than the single long incision and there is minimal soft tissue dissection. Advantages include:

  • Smaller incisions
  • Shorter hospital stay
  • Less trauma to the surrounding tissues
  • Quicker recovery
  • Less blood loss
  • Less scarring
  • Faster rehabilitation
  • Minimal post-operative pain

Furthermore, if desired, special lasers and dermatologic techniques can be implemented to make your scar nearly invisible! Dr. Fabi, in collaboration with world-renowned cosmetic surgeons, has developed a technique called "cosmetic joint replacement surgery".

Minimally Invasive Total Hip Arthroplasty

The minimally invasive total hip arthroplasty surgery is performed under sterile conditions in the operating room under general anesthesia through either one or two smaller incisions.

In single incision minimally invasive approach, your surgeon makes a 3–6 inch incision over the side of the hip to expose the hip joint. The muscles are minimally dissected to reach the joint. The femur is dislocated from the acetabulum. The surface of the socket is cleaned and the arthritic bone is removed using a reamer. The acetabular implant is inserted into the socket using screws or special cement. A liner material of plastic, ceramic or metal is placed inside the acetabular component. The femur or thigh bone is then prepared by removing the arthritic bone using special instruments and shaped to exactly fit the new metal femoral component. The femoral stem is inserted into the femur either by a press fit or using bone cement. The femoral head component made of metal or ceramic is placed on the femoral stem. All the new parts are secured in place using special cement. The muscles and tendons around the new joint are repaired and the incision is closed.

If the surgeon uses the two-incision technique, a 2 to 3 inch incision is made over the groin for placement of the socket and a 1 to 2 inch incision is made over the buttock for placement of the femoral stem. This technique is performed under X-ray guidance and takes longer operative time than the traditional approach.

Minimally Invasive Total Knee Arthroplasty

Minimally invasive total knee arthroplasty is performed under sterile conditions in the operating room under spinal or general anesthesia. You will be lying on your back on the operating table with a tourniquet applied to your upper thigh to reduce blood loss. Your surgeon will then make an incision of around 4 to 6 inches in length along the affected knee to expose the knee joint. This incision is much smaller as compared to the 10-12 inch long incision used in the traditional approach.

The surgeon first focuses on the femur (thighbone). The damaged portions of the femur are cut at the appropriate angles using specialized tools. Then the femoral component is attached to the end of the femur with or without bone cement. The next step involves removal of the damaged area of the tibia (shinbone) and the cartilage. It allows for a smooth surface to which implants can be attached. The tibial component is then secured to the end of the bone using bone cement or screws. Your surgeon will place a plastic piece called an articular surface between these implants to ensure a smooth gliding movement. This plastic insert acts in a similar way as the original articular cartilage and helps in supporting your body weight as well as allowing the femur bone to move over the tibia. The femur and the tibia bone with their new components are put together to form the new knee joint. To ensure that the patella (knee cap) glides smoothly over the new artificial knee, its rear surface is prepared to receive a plastic component. With all new components in place, the knee joint is examined through its range of motion. All excess cement will be removed and the entire joint will be irrigated and cleaned out with a sterile saline solution. The incision is then closed and drains are usually inserted. A surgical dressing or bandage is then placed over the incision.

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