Mountains and triathlons await same-day joint replacement patients

UAB’s same-day joint replacement surgery program is helping patients get back to doing what they love.

Osteo4Lei Liu has hiked all over the world. He says the Kalinchowk Shrine in Nepal, at 12,600 ft above sea level, offers fabulous views of the Himalaya Mountains.One cannot wait to get back on the trail. The other has begun training for a half-triathlon. Both have had knee replacements at the University of Alabama at Birmingham’s Department of Orthopaedic Surgery.  

Lei Liu is a hiker. A big mountain hiker. Until osteoarthritis in both knees made hiking impossible. 

“I’ve hiked in almost all of the national parks in the United States, and in a number of continents around the world,” said Liu, an associate professor in the UAB School of Optometry. “My quality of life was dramatically reduced by the arthritis in my knees.” 

A trip to the Patagonia region in South America in 2017 was the last straw.

“I was trying to hike to a glacier, and couldn’t do it,” Liu recalled. “I had to quit.” 

Liu was referred to UAB orthopaedic surgeon Elie Ghanem, M.D., who determined that Liu was a candidate to have both knees replaced. He had the right knee done in 2019 and spent one night in the hospital. For the other knee, done in early 2020, Ghanem proposed same-day surgery.

“For some patients, an overnight stay in the hospital is not necessary,” Ghanem said. “The sooner patients can return home and return to their normal routine, the better. We want patients to go home and be active through physical therapy, and not be in ‘sick’ mode at the hospital.” 

“I saw no reason to stay in the hospital,” Liu said. “Before I was discharged, I had a physical therapy session and was able to stand and walk with a walker about two hours following recovery. I went home, cooked dinner for myself and did fine.”

Carla De La Garza had a similar experience. A nurse practitioner from Montgomery, she had been a runner, cyclist and swimmer in her younger days. She was working up to doing an Iron Man half-triathlon when she began to experience problems in her right knee.  

Osteo5Carla De La Garza has returned to training for triathlons. She's rather proud of the scar on her left knee!“I had a torn meniscus and had that surgically repaired, but the advanced arthritis in my knee caused it to tear a second time,” De La Garza said. “I was referred to Dr. Ghanem as a candidate for knee replacement.”

De La Garza had same-day replacement surgery May 18. 

“I actually asked Dr. Ghanem the first time I met him if it was possible to go home on the same day as the surgery,” she said. “He told me that was a new option that UAB was offering, and I was a good candidate. I was all for it.” 

“Motivation is a key to the success of same-day surgery,” Ghanem said. “For those with the appropriate support and desire, there is no benefit to staying in the hospital if you are capable of going home.”

Patients who qualify for same-day replacement will receive two or more physical therapy sessions following surgery. They must be medically stable, have pain under control and be able to walk 150 feet to be eligible for same-day discharge. Ghanem says most cases are done under spinal sedation, not full anesthesia. 

“Coming home to your own bed is great,” De La Garza said. “I didn’t have any issues. Did physical therapy, starting walking and riding my bike as soon as I could. I now walk or jog 2 miles three times a week and ride 12 miles or more on my bike.” 

“I saw her for a follow-up visit two weeks after surgery and was amazed,” Ghanem said. “Her recovery was that of a person closer to eight to 10 weeks post-surgery.” 

Currently, same-day discharge is available only for patients undergoing total knee replacement; but UAB is working to develop the same program for total hip replacement.

Osteo3Orthopaedic surgeon Elie Ghanem, M.D., says same-day joint replacement surgery is an option for some patients.Ghanem credits advances in anesthesia as a large part of why same-day surgery can be offered. He says collaborations with physical therapy, nursing and anesthesia are the keys to making the program work.  

“No one would know I’ve had a knee replacement,” De La Garza said. “I have no limp, no pain. I’ve started training again, and am planning to compete in triathlons again once the COVID pandemic allows me to travel.” 

Liu has big plans too. He is walking 4 miles a day waiting for his chance to travel to his next big destination. He is aiming for a trip at the end of year to the Galapagos Islands. 

“That will be a real challenge as the terrain is quite rugged,” he said. “But I’m doing really well and looking forward to it. I wish I’d had the replacements done a long time ago!

UAB Medicine’s joint replacement team performs more than 1,000 hip and knee replacements annually, and that number continues to grow.

For more information on joint replacement surgery, call (205) 930-8339 to make an appointment with UAB Orthopaedics.