Get in, go home: Milwaukee VA offering same-day joint replacement

“It was bone on bone,” said the 57-year-old former drill sergeant, who served in the U.S. Army from 1983 to 2020. “The pounding over the years started to take its toll.”

But thanks to the Milwaukee VA, Harlan has a new knee that has relieved his pain and allowed him to return to activities he loves.

And the best part? Thanks to an efficient, professional and synchronized staff at the Milwaukee VA, he had the surgery and went home the same day.

The Milwaukee VA can now offer same-day outpatient joint replacements to Veterans who meet certain criteria.

“Our actual evaluation of the patient hasn’t changed,” said physical therapist Ashley O’Rourke. “What has changed is our focus of getting them … all set to go home safely the same day.”

Typically, someone undergoing joint replacement stays in the hospital for 2½ days. But those meeting certain criteria can go home the same day.

This requires coordination with all members of the team, including orthopedics, anesthesia, pharmacy, occupational therapy and physical therapy.

The team works with the Veteran to assure safe recovery at home as well as follow-through on a prescribed exercise regimen. Outpatient occupational therapy issues equipment for the patient to use at home.

“We make sure that any help they need at home is already arranged,” said occupational therapist Nicole Stolz.

Before the surgery, occupational therapists will assess the home to make sure it’s conducive for continued recovery and rehabilitation. And there needs to be someone in the home for 48-72 hours after the surgery to assist the patient.

“It’s not a gentle surgery; it’s a major orthopedic surgery,” physical therapist Mike Waller said. “It takes a lot of coordination on the front end to make sure everything falls in line with the surgery, recovery and initiating therapy. A lot of stars have to align.”

Not all candidates for joint replacement can go home the same day. They have to be in fairly good health, and they have to attend a joint replacement “boot camp” where the patients and their “joint coach” — typically the spouse — learn what all is expected to assure a smooth recovery.

Orthopedic surgeon Dr. Karl Scheidt noted that if a candidate checks all the boxes, getting in and out the same day is ideal.

“It has been proven to be safe and effective,” he said, noting that the actual surgery is the same, with only some minor modifications regarding anesthesia. “Rapid mobilization after joint surgery really benefits the patient significantly and gets them functioning quicker.

“And an early discharge leads to less complications post-operatively and less likelihood of the patient getting a hospital-acquired infection.”

It’s also better for the hospital, Scheidt said.

“There’s less utilization of resources needed just to monitor a healthy patient for the 2-3 days. That frees up in-patient beds for other Veterans who need them, and staff can take care of those who need it more.”

For Harlan, the procedure was a long time in coming.

“I was tired of the pain and limping around,” he said, noting that the knee had been getting progressively worse for the past eight years. “I said, ‘Let’s get it done once and for all.’”

After his surgery, the team wasted no time in getting Harlan up and around, walking him up and down the hallway with a walker.

Once at home, Harlan continued to walk, exercise with kettlebells and do squats, trying to do a little more each day. In fact, his wife had to caution him to not overdo it.

He also began attending regular physical therapy sessions at the Milwaukee VA. About a month after the surgery, he was walking with only a slight limp, doing squats while holding a weight and working out on an exercise bike.

Waller said Harlan’s progress was ideal.

“He’s doing really well. He puts a lot of work in,” Waller said. “His range of motion looks great. He’s checking all the boxes and making really steady progress.”

Harlan has been equally happy.

“It’s feeling good now … getting better and better,” he said. “I definitely wish I would have had it done sooner.”