The Bone and Joint Institute of Tennessee Surgery Center completed its first total knee replacement procedure recently, opening the door to serve the growing demand for joint replacement surgeries in an outpatient setting. Still in its first year of operation, Bone and Joint Institute of Tennessee Surgery Center is a state-of-the-art ambulatory surgery center (ASC) in Franklin, TN, just 17 miles from Nashville. The center’s first knee replacement surgery was completed by Cory Calendine, M.D., an accomplished orthopaedic surgeon and one of 12 surgeon-owners of the facility.
More than 600,000 people in the U.S. undergo a partial or total knee replacement operation each year, and that number is expected to grow to 3.48 million by 2030. A rapidly growing percentage of those procedures is being conducted on an outpatient basis, made possible by advances in technology and new pain management techniques.
Calendine says the Bone and Joint Institute of Tennessee Surgery Center is ideally suited to serve joint replacement patients. “We do very high volume of hip and knee replacements at our partner hospital, which is literally situated across the parking lot,” he says. “And just like all good joint replacement programs, we’ve evolved. About 10% of our joint replacement patients at the hospital go home the same day. We’ve been able to move that across the street and offer excellent care in a facility solely dedicated to the orthopaedics. From the nurses to anesthesia to our check-in/check-out staff, every member is specially trained to meet the needs of the orthopaedic patient.”
That specialization is especially relevant today.
“When patients go into the ASC environment, they’re paying an outpatient price with the high quality and focus on excellence. They’re getting a cost-effective option without sacrificing quality of care and are able to go home the same day,” says Stephanie Martin, vice president of operations at Regent Surgical Health, management partner to Bone and Joint Institute of Tennessee Surgery Center.
In addition to specialization, Calendine credits technology as a Bone and Joint Institute of Tennessee Surgery Center strength when it comes total knee replacement procedures. “At our ASC, we have the training and technology to deliver the best results, especially in these younger, healthier, higher demand patients. They need their ‘new parts’ to last longer and longer, and we do that with advanced technology, specifically a robotic platform called Mako SmartRobotics™. Our robotics-assisted procedures are at the next level, offering sub-millimeter precision.”
Calendine explains, “We do a CT scan before we even go to the operating room, so we know not only the shapes of the bone, but the size implant and any special instruments we might need. With that pre-planning, we also have the ability to adjust inter-operatively, to customize the plan to the patient’s soft tissues and demands, and then we use a robotic arm to help us actually execute the plan at the time of surgery.”
The approach was ideal for Bone and Joint Institute of Tennessee Surgery Center’s first total knee replacement patient. According to Calendine, the patient’s goal was to be able to play on the beach with her grandchildren, an activity made difficult and painful by her arthritic knee.
“Her desire was to get back to a more active lifestyle,” he said. “She was motivated. She wanted to get better. She loved the concept of sleeping in her own bed that same night after surgery, and she had COVID concerns as well. At the ASC, the procedure itself took just over an hour and the patient was in our facility maybe two or three hours after that. We were able to get her pain controlled, get her up and moving with our team, and she was asking to go home. She felt perfectly comfortable and safe and continues to do well and exceed her rehab goals.”
Calendine believes the time has definitely come for outpatient total knee replacement surgery. Industry projections suggest half of all total knee replacements will be done on an outpatient basis by 2026. “In order to accommodate that volume safely and effectively, a physician owned, joint venture partnership where the surgeons can control the flow, is really an ideal way to go.”
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