Dr. Berger Knee Replacement Study: Outpatient Knee Replacement Is Realistic
Richard A. Berger, MD is trying to make total knee arthroplasty an outpatient procedure.
One of the more complex surgeries undertaken by orthopedists, Berger believes skilled surgeons and experienced hospital staff can help turn the procedure from a 4-5 day stay to one that is less than 24 hours.
New strategy in Dr. Berger’s knee replacement procedure
“Everything must be perfectly executed to perform outpatient total joint arthroplasty,” Dr. Berger said at a study presented at the 2009 annual meeting of the American Academy of Orthopaedic Surgeons (AAOS).
“Any error or delay from any part of the team will result in the patient’s having to stay overnight.”
Dr. Berger presented data based on 111 patients who had primary knee arthroplasty completed before noon on the day of surgery. Ninety-four percent of test patients were discharged home on the day of surgery.
According to Berger, 1 million patients undergo joint arthroplasty every year, with each spending 4-5 days in a hospital following surgery.
“Think of how much money that could have saved our ailing medical system,” Berger says, suggesting that the majority of joint arthroplasty patients could have been outpatients, eliminating 3-4 million hospital days.
Outpatient knee replacement surgeries viable
But Dr. Berger warns that not all hospitals or surgeons may be prepared to being performing outpatient joint replacement.
“We have been perfecting same-day discharge for hips since 2001 and for knees since 2003,” Berger said of his team at Rush University Medical Center in Chicago.
The Rush Orthopaedic department is considered one of the best in the United States, earning 10th place on US News & World Report’s rankings of the top orthopedic hospitals in the country.
Despite Dr. Berger’s high esteem in the medical community, he has been recently chastised by Zimmer Inc., a medical device manufacturer that Berger has implicated in the sale of a defective knee replacement system called the porous femoral NexGen CR-Flex.
Zimmer knee failure rates excessively high in CR-Flex Model
In 2010, Dr. Berger presented a report which found the device to be connected with a higher than expected rate of Zimmer knee failure in the CR-Flex model caused by component loosening. Dr. Berger and his associate Craig J. Della Valle, MD wrote at the time that the device implicated in Zimmer knee failure “is still commercially available but should not be used for any patient.”
Dr. Berger, once a highly paid consultant for Zimmer Inc., is no longer on the company’s payroll. Zimmer says discontinuing his employment was part of a regular rotation of consultants.
Today, a number of knee recipients have filed a Zimmer knee lawsuit involving the NexGen line of knee replacements systems. Zimmer Inc maintains that Zimmer knee failure is no more likely than knee failure resulting from complications in other knee replacement devices.
It is unclear if any NexGen devices were used in the outpatient knee replacement study undertaken by Dr. Berger.