Marcus A. Rothermich, MD, is an orthopedic surgeon and sports medicine specialist at the Andrews Sports Medicine & Orthopaedic Center in Birmingham, Ala. Here, he shares his thoughts on outpatient orthopedics.
Note: Responses have been lightly edited for style and clarity.
Question: What changes or opportunities are you expecting to see for outpatient total joints in the coming years?
MR: This is an area that is very exciting for a lot of orthopedic surgeons. Traditionally, patients who had total joints could stay in the hospital for several days or a week after their joint replacement. We know now that this is dangerous to the patient in terms of infection risk and the development of blood clots, so getting patients back home sooner is a major benefit in modern outpatient centers performing total joint surgery. As time goes on and we see more long-term outcomes in these patients, more centers will begin doing total joints as outpatients moving forward.
Q: Are there any kind of overarching trends that you're seeing right now in outpatient orthopedics?
MR: In general, surgeons are getting more comfortable performing many surgeries in outpatient centers that were once reserved for an inpatient hospital setting. The improvement of anesthesia and local nerve blocks has helped make outpatient surgery a reality for a large variety of procedures today.
Q: How do you hope the ASC industry will change in the coming years?
MR: I think we will see a continuation of recent trends from the past decade or so. Private physician ownership and an increase in the capability of these centers will continue to provide many convenient benefits to patients undergoing outpatient surgery.
Q: Is there any new technology you're looking forward to on the horizon?
MR: Two major areas of research in recent years have included robotic joint replacement and the introduction of regenerative medicine for arthritis, sports medicine injuries and even in the trauma setting for nonunions or chronic malunions. Both of these topics are of great interest to orthopedic surgeons who take care of patients with arthritis and chronic pain. We look forward to implementing these new technologies in the outpatient setting moving forward, as long-term research studies start coming out describing patient outcomes.
Q: Do you have any tips or things to know before starting a total joint program?
MR: I typically have long discussions with my patients battling arthritis regarding their conservative and surgical treatment options. In addition to the traditional nonoperative treatment methods of physical therapy, weight loss, anti-inflammatories, cortisone injections and viscosupplementation, new innovations in regenerative medicine have made platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) options for patients with arthritis. When these conservative measures no longer suffice in treating the pain, we then start discussing surgical options, including arthroplasty. Many patients think they need to wait until they are as old as possible to get a knee replacement, but we have had great success in treating younger patients with functional arthroplasties as well. These patients typically enjoy an excellent functional recovery and have noted that joint replacement can be a game changer in getting back to the activities they enjoy.
Q: Do you think private equity will have an impact on the orthopedic specialty? Why or why not?
MR: The recent growth of private equity investment in ASCs has certainly had an impact on outpatient orthopedic surgery. The next few years will be very interesting to see that growth compared to the investment of hospital systems in these outpatient centers. In general, private equity ASCs make outpatient joint replacements more common, whereas hospital-owned ASCs prefer to keep joint replacements in the inpatient hospital setting. As more surgeons become interested in performing joint replacements in surgery centers, it will be very interesting to watch how those investment patterns evolve between private equity firms and hospital systems.