Doug's story: The will to move without pain

After struggling with joint pain for years, Doug chose to undergo hip and knee replacement surgeries at Brigham Health. To his delight and surprise, in both cases he was able to go home the very same day as his surgery.

Doug was in the midst of a transformation by the end of 2015. Having suffered joint pain since his days on the high school football team, Doug, 67, was in the process of having several joints replaced, a surgical undertaking that began earlier that year with his right hip.

"After my first hip replacement, I realized that I was truly beginning a journey," Doug says. "I've had one hip replaced, I've got one more hip and two more knees to replace, and it's going to take years to do."

After his first hip surgery, Doug decided to meet with a new surgeon, Dr. Vivek Shah, for a consultation about the rest of his joints. While they reviewed the details of his procedure, Doug asked Dr. Shah about the possibility of having both knees replaced during the same surgery.

"He immediately got a very serious look on his face and said, 'I was afraid you were going to ask me that,'" Doug recalls. "I asked if there was a problem, to which he responded: 'Well, that just means a lot of work for me.' And then he smiled."

At this, Doug burst out laughing. "Though we decided it was best to do one knee at a time, the fact that he was able to lighten the mood while we're talking about something very serious made me feel at ease with him, and I remember thinking: Okay, this is the guy who I want to do the rest of my surgeries."
Doug's right knee was in the worst shape, so the plan was to start there while managing his left hip and knee with more conservative treatments. Later, after undergoing surgery on his right knee, Doug reconnected with Dr. Shah, now Director of Outpatient Arthroplasty in the Department of Orthopaedics at Brigham Health, for a round of x-rays. When the results showed further degeneration to the left hip and knee, Doug knew it was time to move forward with another round of surgeries.

"As always…you're unsure of what could happen," Doug says, "but right from reception the whole team at Brigham Health was attentive, organized, and knowledgeable, answering all my questions. When I left that first day, I felt very good moving forward."
Doug and the Brigham team set a date for his next hip surgery—and to Doug's surprise, he discovered that, if he wanted to, this would also be the day he'd get to leave the hospital.

One day away from home

After his first hip surgery, which had been done at a different hospital with a different surgeon, Doug recalls needing to wear a soft cast from his hip all the way down to his ankle while enduring an extended recovery in the hospital. For his forthcoming hip surgery at Brigham Health, the team presented him with an option that he didn't even know was possible: a joint replacement surgery that would allow him to return home on the same day.
For qualifying patients, the same-day joint replacement program—also known as outpatient joint replacement—gives them the resources to prepare for a recovery period that they can experience from the comfort of their own home, starting on the day of their procedure. On average, patients who undergo same-day joint replacement surgery are able to get back on their feet in two hours, which is ten hours sooner than patients who undergo an inpatient procedure.

"We know that getting patients out of the hospital quickly reduces their risk of many complications, the biggest of which being infection," Dr. Shah says, "but we also find that patient's general comfort level is increased, all of which helps better control their pain levels and ease their recovery."
Doug's team at Brigham Health—consisting of orthopedic surgeons, physical therapists, and physiatrists—provided him with extensive resources, like pain management strategies and prehabilitation (pre-operative physical therapy) guidelines, to help him feel confident taking his recovery home. His family was also briefed on everything they needed to give him the right care. "The Brigham treated us like part of Doug's team, informing us about what to do in case anything came up, answering any questions, and making sure we felt prepared for any situation," says Joan, Doug's wife. "We were just as much a part of the procedure as Doug was."

This all makes the preparation process more educational, while increased communication makes the process more comforting overall.
"Some people's biggest concern about same-day surgery is feeling like they're being left on an island to care for themselves, but the number of conversations that my staff and I have with our patients before and after surgery is actually more than for people who stay in the hospital, so I think in many ways it becomes more personal," Shah says.

In January 2019, with all preparations in place, Doug underwent full hip replacement surgery on his left hip. After a physical therapist came around to ensure he was comfortable using the devices he needed, Doug was released from the hospital.

"Waking up in the morning and being in my own home, instead of being in a hospital bed where I don't sleep well because of all the lights and the beeping and the vitals checks, was the best way I could imagine starting my recovery," Doug says.

A brand new man

Four months after his second hip surgery, the pain in Doug's knee became too painful to ignore, driving him into the operating room six months earlier than he'd originally planned. Dr. Shah and team didn't falter. "They just handled it so well, getting me in, walking me through it, and making sure I was taken care of."

This surgery was also a same-day joint replacement, but simply because Doug and his family had done this once before did not mean they were forced to return home immediately.

"After both surgeries, we never felt pressured to leave on the same day," Joan says. "It was always our decision, and we felt ready thanks to all they did to prepare us for what came next."

And what comes next is still unfolding. Now with four new joints and only a short while of formal recovery left to go, Doug is already feeling like his old self again, with plans for what adventures he'll take once he's back in shape.

"I'm excited to get back to skiing, which is something that we've done as a family since my daughters—who are now in their mid-20s—were very young," Doug says. "One of my favorite pictures is all of us on Wildcat Mountain from years ago. Someday, maybe even this winter, we'll all go up there again and recreate that picture."

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