Same-day joint replacements help support access to surgeries during COVID-19

Barry Scott apple picking with his grandson this fall.
Barry Scott apple picking with his grandson this fall.

“Amazing. Night and day. It has changed my life.” That is how Barry Scott of Halifax describes the relief he felt following his hip replacement surgery this summer.

After his arthritis progressed and led to shooting pain that would wake him at night, Scott became one of the first patients to have a same-day joint replacement at the Halifax Infirmary, part of the QEII Health Sciences Centre. 

He arrived at the hospital at 6:30 a.m., had his surgery at 8:30 a.m., and was up walking - nearly pain free - just a few hours later. Scott was back home with his wife by 2:30 that afternoon.

Scott knew eight years ago that his hip arthritis would eventually make him a candidate for a new hip joint. 

While he considered surgery several years ago, the timing wasn’t right and the pain was still manageable. But as the symptoms grew worse, he saw his surgeon, Dr. Michael Gross, about a year ago and agreed it was time. 

“I never wanted to be admitted to the hospital and had asked my surgeon if I could go home the same day,” said Scott. 

Although his surgery was originally scheduled for March, he was among the more than 3,200 patients to have their elective surgery postponed to free up resources to support the COVID-19 response. 

With the number of COVID-19 cases declining, in late May Nova Scotia Health began gradually increasing surgeries and other services impacted by the pandemic. 

The initial focus was on rebooking patients who had their scheduled surgeries postponed and offering day surgeries, which would not require a patient be admitted to a hospital bed. 

Same-day, or outpatient joint replacement surgeries, have been offered to some otherwise healthy patients at Dartmouth General Hospital since the summer of 2018. 

Before the COVID-19 pandemic, Nova Scotia Health was exploring the potential to introduce same-day joint replacement surgeries at other locations. 

The service was being considered as part of the multi-year plan to improve access and care for hip and knee joint replacement patients.  The plan has increased the focus on wellness and supporting patients to prepare for surgery and a successful recovery.

“COVID-19 set us back a bit in our efforts to increase access to joint replacements and with access to inpatient beds still limited due to COVID-19, the timing was ideal to proceed with our same-day joint replacement plan,” said Dr. William Oxner, head of the Division of Orthopedics, QEII Health Sciences Centre. 

“While not all patients are eligible, to date we have been able to support more than 60 patients to return home the same day as their surgery.” 

Scott is pleased with his progress and hopes everyone feels as well as he does after surgery. 

“I had excellent pre-op and post-op care, and my surgeon was fantastic. I felt really well taken care of.”

He credits following the exercise program he was provided to complete at home as key to his positive outcome. Scott is going to the gym regularly, getting out for walks and seeing a physiotherapist to continue getting stronger.  

Patients are typically offered several weeks of in-person pre-habilitation before surgery, but this group-class approach to exercise and education is being adapted due to COVID-19, with more virtual classes, home-based activities and smaller groups classes in some areas.  

“A lot of people think they have to stay in hospital, but as long as you are healthy and have the right set-up and people around to help you, then I would recommend it [same-day surgery].” 

Learn more about Nova Scotia’s multi-year hip and knee action plan.