Advances in minimally invasive surgery enable patients to have an operation in the morning and walk out that afternoon with a new hip or knee.
Peter Mavraganis’ right knee lasted longer than expected. Mavraganis had injured it in his late teens, and though he’d had cartilage removed at the time, he recovered and remained active and fully functional until he was 75 years old.
Over the years, Mavraganis had twice undergone arthroscopic surgery to clean up the remaining cartilage. And despite further erosion of cartilage from age, he was able to do almost any activity he wanted, pain-free. Then, in the fall of 2023, his condition worsened.
Mavraganis’ knee had been “bone-on-bone” for some time, but now he felt pain and abrasion when he moved. His knee also lost all lateral range of motion. Mavraganis’ doctor said there was nothing more they could do to save his original knee joint.
“He told me I had stage four osteoarthritis and that the only real answer was to do a knee replacement,” said Mavraganis. After discussing it with his wife, Elizabeth, and the doctor, he decided to move forward with surgery.
Joint replacement surgery, refined
During the last 20 years, as Mavraganis’ knee joint was slowly deteriorating, the surgery he’d need to replace it was steadily evolving.
Brian Culp, MD, who is board certified in Orthopaedic Surgery and medical director of the Center for Joint Replacement at Penn Medicine Princeton Medical Center (PMC), explained how knee and hip replacement surgery has advanced from decades ago: Materials used today in artificial joints (implants) last longer and are more effective and pain control has improved dramatically. Recovery time has shortened as well.
A joint replacement used to mean spending a week in the hospital, followed by a stay in a nursing facility. Within the last 10 years, patients have been able to recover at home after only a night or two in the hospital. And in recent years, the surgery has been further refined to allow most patients to go home the same day.
Same-day joint replacement
Culp was trained in a surgical method that limits the cutting of muscles, tendons, and ligaments, enabling patients to recover much more quickly. When Culp came to PMC to launch a same-day joint replacement program, he brought those same techniques.
“At first, we offered same-day joint replacement mainly to younger, healthier patients,” Culp said. “Then we began to hear from many other patients that they wanted to go home soon after surgery, so we started to figure out strategies to expand that type of care to more and more eligible patients.”
Culp said unless a patient has uncontrolled health issues that require closer monitoring following surgery, it’s no longer necessary to keep them overnight.
“There is a lot of literature that says there’s no worse complication rate if you go home, as long as you follow the criteria of who’s healthy and who’s not,” Culp said. In fact, “the risk of complications, like having a blood clot or a readmission, are the same or better for folks who go home the same day.”
Preparing for surgery
In late 2023, when Mavraganis decided to move forward with total knee replacement, his orthopedist prescribed four weeks of physical therapy (PT) first, to strengthen the quadricep and hamstring muscles that support the knee. Prehabilitation (or prehab) is a proven strategy that significantly aids in recovery.
And because he was retiring at the end of the year, the orthopedist referred Mavraganis to his colleague, Dr. Brian Culp.
In early January 2024, Mavraganis visited Culp, who confirmed that knee replacement was appropriate. Mavraganis and his wife were primarily concerned with what his knee would look like after surgery and how it would function. But, he said, if Culp could do the procedure in a way that would allow him to leave the hospital with a walker on the same day, “that was certainly our preference.”
‘A fantastic experience’
In early March, Mavraganis had surgery at Princeton Medical Center. Culp said whether his patients have surgery in the hospital or an outpatient center, “they get the same implants, the same anesthesia, the same modern protocols.”
Mavraganis and his wife arrived at 5:30 a.m. and were taken back for pre-op prep. He appreciated that his wife could stay with him right until he was wheeled into the operating room, where he was administered a spinal anesthesia and put to sleep for the procedure (similar to being asleep during a colonoscopy).
After surgery, once the anesthesia had worn off, Mavraganis was out of bed and using a walker. At 3:30 p.m. the staff helped him into his car and his wife drove him home.
“It was a fantastic experience,” he said. “The staff was excellent and gladly answered any of our questions without hesitation. And what really impressed us was that everybody had a job to do and knew exactly how to do it. They made us feel comfortable and it went like clockwork.”
A shared goal: get patients moving
Culp said the advances that made same-day surgery possible benefit all patients undergoing joint replacement—from minimally invasive approaches to shorter-acting anesthesia to more proactive methods for pain control. Patients are encouraged to walk from day one, and even those who stay overnight are up and moving the same day as their surgery.
Mavraganis left the hospital with a personalized discharge plan, including safe and effective pain management. His recovery went smoothly, and he was pleased by the follow-up care. “They called me the next two days to check on my pain and sent a handful of text messages over the next several weeks,” he said.
Two weeks after surgery, he had a follow-up with Culp, and then started outpatient PT three times a week. Today, most patients begin outpatient PT a day or two after returning home from surgery, but Mavraganis was deemed not to need it right away. “The physical therapist said that the prehab really helped my recovery,” Mavraganis said.
Two months later, Culp cleared Mavraganis for most activities, barring contact sports.
Now more than 90 percent recovered, Mavraganis is enjoying the summer on Long Beach Island, fishing, running after his four grandkids, and taking long walks with his wife.
“Prior to surgery, I had to stop walking after three-tenths of a mile because it was just too painful. Now I’m back to walking two miles with no problem,” he said.