The recent completion of the first outpatient anterior total hip arthroplasty at Bone and Joint Institute of Tennessee Surgery Center in Franklin, TN, was an especially notable accomplishment for orthopaedic surgeon Brian Perkinson, M.D., one of the center’s twelve surgeon-owners. The procedure opened the door to serve growing demand in the area for total hip surgeries in an outpatient setting, but also had personal significance for Dr. Perkinson.
“I’m from Franklin, I grew up in this town,” he explains. “I’ve had the good fortune to be able to come back and practice with the orthopaedic group that took care of me when I was a kid. To be a part of bringing this cutting-edge technology and an amazing facility to my hometown, serving my own family and friends, has been a blessing in my life and a milestone in my career.”
Still in its first year of operation, Bone and Joint Institute of Tennessee Surgery Center is a state-of-the-art ambulatory surgery center (ASC) just 17 miles from Nashville. While growing up, Perkinson’s father was a banker in Franklin and his mom, a teacher in the local high school. Perkinson is an accomplished orthopaedic surgeon, having completed approximately 250 total hip procedures annually at the hospital, about 20% of them on an outpatient basis, over the past 4-5 years.
“We have spared no expense at our ASC to provide the same level of technology and quality to our patients at the ASC than they receive at the hospital,” Perkinson says. “For example, we utilize robotics-assisted joint replacement surgery at our hospital. We purchased and now utilize robotics at our ASC, and we are one of very few freestanding ambulatory surgery centers that have robotic technology available to them.”
Preparation for Bone and Joint Institute of Tennessee Surgery Center’s first anterior total hip replacement procedure goes back more than five years and came with a natural progression of both the techniques and technologies to support success on an outpatient basis.
“We’ve been building this outpatient program at the hospital since 2015, and we basically got it down to where, once we opened our ambulatory surgery center, we were ready to move it to a true outpatient model,” Perkinson says. “There’s not one singular thing you do that just makes everything just go outpatient overnight. It is really getting everyone at the facility involved – particularly your anesthesiologists, your nursing staff, and your surgical technicians – getting them all on the same page and coordinated to every detail of the patient’s care.”
“As a result of this preparation, the first total hip replacement at Bone and Joint Institute of Tennessee Surgery Center was wonderfully smooth and successful”, he says. Perkinson prefers the anterior approach to outpatient hip replacement surgery because as a less invasive technique, he believes the approach allows for earlier functional recovery. The anterior approach is a newer technique, producing excellent outcomes and well-suited to the outpatient environment.
“I would say that anterior hip replacement surgeons are probably driving the shift to outpatient joint replacement, but it’s not that you can’t do it posteriorly. Plenty of posterior hip replacement surgeons do outpatient joint replacement as well,” Perkinson says. “The thing you focus on when you move to an outpatient setting is minimizing your surgical technique; performing the surgery in the most minimally invasive way that you can do the surgery and still have the same excellent outcomes.”
A state-of-the-art facility, BJIT was designed specifically with outpatient orthopedic procedures in mind.
Says Perkinson, “We were able to design our ASC in conjunction with our partners, and so we have tremendous lighting systems. We have large open spaces. We have a cutting-edge central facility for sterilizing our equipment. We have large screens for interoperative imaging. We have beautiful preop and postop areas with separate rooms for our patients. But the big advantage that I saw moving from the hospital to the ambulatory surgery center is the mindset of ‘we do outpatient joint replacement and this patient goes home today.’ All the staff are on the same page from the moment the patient checks in at reception to the moment they walk out of the building after their joint has been replaced.”
“The patient feeds on the positivity and the confidence of everyone they speak to,” he continues. “They know that here; we do successful outpatient joint replacement and they’re going to walk out of this building after surgery and go home safely that same day.”
Click here to learn more about the Bone and Joint Institute of Tennessee Surgery Center.