Using a combination of all of the above techniques has allowed us to substantially decrease the length of hospitalization for all hip surgeries. When I was a resident at Johns Hopkins Hospital over 25 years ago, the norm was a one-week hospital stay followed by a 1-2 week rehab facility stay. While the national average hospital stay is still 3-5 days postop.

My average hospital stay has been 1.5 days for years. Minimally invasive surgery in combination with the other techniques of perioperative management have now made it possible to routinely offer outpatient surgery to all young healthy patients (currently only for BC/BS insurance). Many patients prefer avoiding a hospital stay, and the overall costs are lower.

Unfortunately many insurance carriers are large bureaucratic organizations that are slow to innovate, even when it may benefit their bottom line. Change is slow. But the point is to highlight the revolutionary change in hip surgery techniques over the last few decades.

So far we have had no major problems. We will reach 100 patients by mid 2014; a scientific publication will follow.