Is Outpatient Joint Replacement An Option For You?




If you are healthy enough, outpatient joint replacement (where you have surgery and go home on the same day) may be an option for you at EmergeOrtho.  In comparison to inpatient joint replacements, much of the process remains the same but there are a few differences.  Special consideration of the medical status of the patient is the biggest factor.  Anesthesia techniques (to make you more comfortable) are modified for outpatient replacement patients.  Physical therapy at home is begun the day after surgery.  Since you won’t be at the hospital where the surgical team can check on you, an earlier follow-up appointment is scheduled.  Lastly, you’ll need a caregiver or team of caregivers present with you to assist with walking, medications, and meals.

Some of the advantages to outpatient joint replacement include:

1) cost

2) convenience/comfort

3) fewer complications

Outpatient joint replacements often offer substantial cost savings since there is no hospital stay.  Also, they can be done at “surgery centers” which typically charge significantly lower fees than typical hospitals might.  Many patients are more comfortable being at home in a familiar environment while they recover.  Patients may be more likely to avoid complications since they are likely to move around the home more than they might at the hospital.  Lastly, the chance of picking up an infection from something or someone at the hospital is lessened the shorter the amount of time spent there.

Sometimes patients scheduled for outpatient surgery may end up having to stay at the hospital (or may be sent to a hospital from a surgery center) if unforeseen complications occur.  To lessen this risk, the patient’s health is carefully screened prior to surgery.   The bottom line is your safety is our top concern.


The main differences between inpatient and outpatient joint replacements at the surgery center involve the type of anesthesia used.  Outpatient patients often get a shorter-acting “block” or injection to allow them to move their legs sooner.  A long-acting “local anesthetic” to numb the tissue around the incision is frequently used to help provide comfort.  Special combinations of pain and nerve medications may be prescribed.  Generally, urinary catheters are not used for patients undergoing outpatient joint replacement.

Rather than being transferred to a hospital bed (also called “the floor”) after surgery, you will have physical therapy (PT) when recovered enough in the post-anesthesia care unit (PACU). When you have proven you can walk appropriately with PT and are felt to be safe to be sent home, you will be discharged. Patients undergoing outpatient joint replacements may stay in the PACU longer than inpatient replacement patients since they need to be fully recovered before being released.



  • Take your medications as directed in your discharge paperwork
  • Your leg muscles may be weak for the first day or so – make sure to wear any braces sent home with you and use your walker or crutches when you move around
    • Do not stop using braces until you are advised to do so by your therapist or surgical team
    • Try to drink plenty of fluids and eat a healthy diet – you need energy to heal
    • Follow the instructions for your dressings and showering given to you at the time of discharge


To learn about whether outpatient joint replacement surgery would be a good fit for you, visit or call (919) 220-5255 to schedule an appointment with one of our surgeons.


Article By: William Silver, MD, Orthopaedic Surgeon, Medical Director, EmergeOrtho Triangle Division

Injury Prevention: Reduce Risk of ACL Tears in Pre-Season

Warmer weather means pre-season starts soon for many sports.  The pre-season is an impactful time for injury prevention: eight to ten weeks of proper conditioning can reduce risk of an ACL (anterior cruciate ligament) tear by 60-90%!

Shepherd Rosenblum MD recently wrote an article for a recent Healthcare Guide with The Franklin Times, “Understanding and Preventing ACL Injuries.” He shares that of the 250,000 surgical ACL repairs each year, most injuries are non-contact.  This means cutting, twisting, and landing are risks for tears – and opportunities for pre-season training.  Increasing agility, balance, strength, and core strength with neuromuscular training enables athletes to improve their alignment and protect their knees.

ACL Sports Medicine

Dr. Shepherd Rosenblum is a board certified, fellowship trained orthopaedic surgeon specializing in Sports Medicine, shoulder, hip, and knee arthroscopy and reconstruction, and

cartilage repair. He has expertise in treating a wide variety of sports-related injuries, as well as problems related to degenerative conditions such as rotator cuff tears, ligament and cartilage problems of the shoulder, elbow, hip, knee, and ankle. Dr. Rosenblum has been in practice since 1995, and has great experience in helping his patients to return to health and activities as quickly and safely as possible. He relies on a variety of techniques, emphasizing conservative management whenever possible, but Dr. Rosenblum is also able to offer the most advanced, minimally invasive surgical techniques available to his patients.

To schedule an appointment with Dr. Rosenblum or any of our Orthopaedic Surgeons, please contact us at 919-220-5255.

Read Dr. Rosenblum’s article in the 2016 Healthcare Guide of the Franklin Times (or click the image below to enlarge.)


Copy of Rosenblum ACL

First Outpatient Knee Replacement Performed at Triangle Orthopaedics Surgery Center, LLC

For Immediate Release: January 8, 2016

Triangle Orthopaedic Associates, P.A.

Contact Person: Chris Adkins, CAO

Triangle Orthopaedics Surgery Center (TOSC) has performed its first outpatient knee replacement.  Instead of spending multiple nights in a hospital, the patient was able to have surgery in the morning and recover at home in the afternoon.  As a single-specialty surgery center dedicated to Orthopaedics, TOSC provides consumer-focused care with better control over the clinical environment than larger organizations such as hospitals.   TOSC is 100% physician owned, allowing physicians to personally guide innovative strategies in care delivery, such as performing joint replacements in an outpatient setting.

“National trends are moving towards performing Orthopaedic procedures, including joint replacement, in an outpatient center.  Triangle Orthopaedics is on the forefront in North Carolina by bringing this high level specialty care to our patients that require joint replacement.  We strive to provide solutions for patients in a safe and affordable surgical environment which allows them to start their recovery at home where they are most comfortable,” says Dr. William Hage.  Dr. Hage, an Orthopaedic Surgeon at Triangle Orthopaedic Associates, P.A. and the Medical Director of TOSC, performed the surgery.

“We provide superior patient care for a procedure that can sometimes require a several day hospital stay.  Our goal was to accomplish this without sacrificing patient safety while still providing pain control and maximizing early ambulation,” says Dr. Scott McCulloch, anesthesiologist.  “We are excited to soon extend this outpatient service to include total knee, hip and shoulder replacements.” McCulloch is with Regional Anesthesia, PLLC and serves on the Medical Executive Committee for TOSC.

Howard Mullins, Administrator at TOSC, states, “We take pride in patient-centered care, high quality outcomes, increased patient satisfaction, and decreased out-of-pocket costs.  As an Ambulatory Surgery Center, we offer increased flexibility based on the individual patient’s needs, including more individual control over personal postoperative recovery.”

TOSC is conveniently located near the intersection of ACC Boulevard and Brier Creek Parkway in Raleigh.  TOSC opened in February of 2013 to provide more cost-effective and efficient ambulatory surgical services than hospital-based or multidisciplinary operating rooms.  The shift from inpatient to outpatient services is pushing innovation, and many surgical procedures are less invasive than before.   Traditionally, an inpatient hospital stay was required for all joint replacement procedures.  Advances in surgical technique, implants, comprehensive blood management, and multimodal pain management have markedly reduced the hospital stay and have virtually eliminated the need for extensive formal rehabilitation. As outpatient joint replacements become possible, TOSC furthers its mission of increasing accessibility to affordable quality medical attention for North Carolinians.

For more information on Dr. Hage and Triangle Orthopaedic Associates, P.A., please visit:

For more information on Triangle Orthopaedics Surgery Center please visit:

To schedule interviews and for assistance regarding this story, please e-mail Chris Adkins at

Join us in Welcoming Our Newest Orthopaedic Surgeon



Please join us in welcoming Dr. Douglas Freels,MD, to our orthopaedic team!  He will be seeing patients at Wilson Ortho, a division of Triangle Orthopaedics.

Dr. Freels has extensive experience in orthopedic surgery and joint replacement patients having been in practice for over 18 years. This includes both primary hip, knee, and shoulder replacement patients including minimally-invasive joint replacement surgeries such as the “Oxford” partial knee replacement and the direct anterior approach for hip replacement surgery. He also has experience in the more complex joint replacement patients including infections, peri-prosthetic fractures, and revision joint replacement surgery.

To see Dr. Douglas Freels,MD, please contact us at 252-243-9629.



Considering MAKOplasty

Considering MAKOplasty at Triangle Orthopaedics

At Triangle Orthopaedics, we are always looking for the best ways to help our patients return to the activities that they enjoy quickly and with less pain. With the MAKOplasty treatment option, patients can experience partial knee resurfacing and total hip arthroplasty with added precision, allowing for restored mobility and the ability to return to active lifestyles.

Through this Triangle Orthopaedic blog, you will learn more about the benefits to considering MAKOplasty, and how to schedule a consultation with one of our specialists.  Keep reading to learn more about this state-of-the-art technology and technique available at Triangle Orthopaedics.

What Are the Benefits to MAKOplasty?

MAKOplasty is currently used at Triangle Orthopaedics for partial knee resurfacing and for total hip arthroplasty.  MAKOplasty procedures are performed with an extremely advanced, surgeon-controlled robotic arm.  Typically, this procedure is conducted to help individuals with non-inflammatory or inflammatory joint disease.

For patients with early to midstage OA in the medial, patellofemoral, or in both compartments of the knee, MAKOplasty can serve as an effective treatment method.  With MAKOplasty Partial Knee Resurfacing, patients may observe the following benefits:

  • Optimal implant positioning, which allows for a more natural feeling post-surgery.
  • Faster recovery and decreased length of hospital stay when compared to traditional knee replacement surgery.
  • Can be an outpatient procedure.
  • Quicker pain relief and return to normal activities.

A MAKOplasty hip procedure provides numerous benefits to a patient including:

  • Stable biomechanical reconstruction with matched leg length restoration.
  • Real-time data for surgeons to most optimally align and position implants.
  • Decreased recovery and pain associated with surgery.
  • Ability to return to normal activities sooner than with traditional hip replacement.

During a consultation, your physician will discuss your individual MAKOplasty options with you, and evaluate if the procedure is a good solution for you.  To learn more about MAKOplasty, please contact our North Carolina Triangle Orthopaedic centers today.

Learn More about MAKOplasty

If you would like to learn more information about MAKOplasty, please do not hesitate to contact our team of experts at Triangle Orthopaedics.  We will answer all of your questions related to the procedures, and help you to further understand the specific risks that may be associated with each procedure.

At Triangle Orthopaedics, your health and wellness are of the utmost importance to us.  With MAKOplasty and our team of orthopaedic physicians, you can return to the activities that you love, with less recovery time than ever before.  Learn more today by contacting our North Carolina Triangle Orthopaedic clinics at 800-359-3053.


Physical Therapy

Physical Therapy and Triangle Orthopaedics

When an injury becomes painful or disabling, many individuals wonder if they will ever be able to regain strength or if the area will ever be pain free again.  This is where the Triangle Orthopaedic team of rehabilitation medicine physicians can help.  Our team is able to treat any disability ranging from various diseases to sports injury, all without surgery. (more…)