By: 25 January 2024
Transforming post-surgical outcomes in the US with medical technology

Approximately seven million orthopaedic surgeries [1] are carried out in the US every year, with total knee arthroplasty (TKA) and total hip arthroplasty (THA) among the most common procedures [2] outside of drainage/injection and venipunctures.

Orthopaedic surgery is often the last resort for patients unable to reap the benefits of other forms of treatment such as physical therapy, massage therapy, medication, or lifestyle changes. Chronic pain and immobility as a result of broken bones or fractures are the leading reasons for patients requiring surgical intervention.

Despite having a success rate of up to 98% [3] in the US, orthopaedic surgery can pose a wide range of adversities for patients that can lead to ongoing pain and discomfort, ultimately delaying patients reaching a full recovery.


Edema and the risks in recovery

Edema (swelling) is a common physical reaction that occurs following orthopaedic surgery. As the body begins to heal the surgical wound, extra fluid builds up around the affected area in the tissue to promote healing, prevent infection and help the tissues recover. Although it is a natural component of the recovery process, edema itself can contribute to further pain and limit mobility.

Some patients may experience edema up to six months [4] (and longer) following the procedure, impacting their ability to resume life as normal. Patients experiencing edema should be conscious of the risks associated with swelling, and understand that – although common – it could be an indication of a more serious condition such as an infection or deep vein thrombosis (DVT). Without relevant prophylaxis, approximately 80% [5] of orthopaedic surgical patients will develop DVT, and between 10% – 20% will develop pulmonary embolism (PE), which can be life threatening. Understanding the recovery process is therefore vital in preventing serious complications.


The financial burden of orthopaedics

Orthopaedic surgery can place a financial burden on the healthcare system and many families in the US, with TKA costing $19,995 [6] without health insurance and more complicated procedures such as a total hip replacement surgery costing up to $40,000 [7]  for an uninsured patient. The average length of stay following orthopaedic surgery is approximately three days [8], which can cost around USD $8,226 [9] on average, indicating the proportion of costs associated with hospital recovery.

The level of 30-day hospital readmissions or unplanned return to operating room (UROR) in the US following orthopaedic surgery is reported between 4 and 7% [10]. Patients can be readmitted with serious medical or surgical complications of the original hospitalization, which can be costly and harmful. In other cases, patients may return to hospital if they are not recovering as well or quickly as they should. For 90-day readmissions for THA and TKA, payments can range from ~$7,000 to ~$15,000 [11] depending on Center for Medicare and Medicaid Services (CMS) complications. One in ten patients return to ED within 90 days of total joint arthroplasty

(TJA), incurring costs for clinician time and the diagnostic scans and tests to determine and prescribe appropriate treatments.


New methods of care

With medicine reaching the frontiers of what is possible in orthopaedic surgery, healthcare professionals are looking to recover new ways to optimize patient outcomes and reduce health costs. Fortunately, new initiatives like Enhanced Recovery After Surgery (ERAS) protocols – also referred to as “fast track”, “accelerated,” or “Rapid Recovery” [12] in the US – have garnered significant focus due to their ability to manage immediate post-surgical complications, allowing for earlier mobilization, shorter hospital stays, and a quicker return to life as normal.

ERAS was initially pioneered for colorectal surgery in Denmark in 1997 [13] by Professor Henrik Kehlet, with its principles eventually spreading to healthcare systems around the world. Enhanced recovery principles consider all elements of care and treat surgery as a process in its entirety, from optimizing pre-surgical consultation and planning to advancing recovery. This involves assessing patient fitness pre-operatively, promoting minimally invasive surgery, and creating a structured approach to recovery to minimize post-surgical pain, encourage quicker mobilization and early nutrition.

ERAS protocols have been proven to improve the patient experience and satisfaction, reduce the length of hospital stay, limit postoperative complications, and minimize readmissions after discharge. The success of ERAS depends on the engagement and collaboration between healthcare professionals and patients.


The role of MedTech

As ERAS methods are increasingly adopted into medical practices, healthcare professionals will begin to look to innovation to support patients through the recovery process. Aiding the mission to reduce the surgical impact on patients – both physically and financially – is medical technology (MedTech).

MedTech that is non-invasive and simple, safe and easy to apply, provides an appealing alternative for healthcare professionals and patients that can enhance recovery by reducing postoperative complications, like edema, to help manage pain and accelerate a patient’s journey to mobility. Medical devices are being introduced into care pathways to enable shorter hospital stays and enable patient rehabilitation to begin sooner, even supporting recovery in the home setting.

The benefits of MedTech adoption address many existing barriers in the current delivery of orthopaedic care – speeding up recovery means that patient rehabilitation can begin sooner, reducing the chance of infections developing, and reducing pain more quickly. This means patients can become mobile sooner, helping to prevent the risk of serious complications like DVT or PE. The quicker and more effectively patients can recover, the fewer post-op hospital visits will be required, saving considerable costs for patients. Some medical devices are even suitable for use in the home setting for able patients, requiring less time and resources from healthcare services.

Implementing MedTech into ERAS protocols will help healthcare professionals maximize the potential of the recovery process, helping to reduce complications in the 30 and 90-day postoperative periods, contributing to reduced emergency department visits and saving time, resources and costs.


New ways to innovate in healthcare

Considering orthopaedic surgery as an all-encompassing procedure from pre-operative preparation to complete recovery is helping healthcare professionals better understand where improvements in care can be made across the board. Through ERAS pathways, healthcare systems can take a more patient-centric approach to recovery by reducing the length of hospital stays and readmissions, improving patient outcomes and benefitting the wider healthcare system in the process. Looking ahead, ERAS should be implemented across all orthopaedic procedures to maximize outcomes and identify any unmet needs that can be addressed with the help of medical innovations, though more research is required to ensure these protocols can combine with innovation to deliver safe and cost-effective care.



  1. The Evidence Supporting Common Orthopedic Surgeries Is AWFUL – Regenexx
  2. Most common orthopedic surgeries | Orthopedic procedures (
  3. 7 Million Americans Living With Implants – Orthopedic Associates SC (
  4. Swelling after Total Knee Replacement – Complete Orthopedics (
  5. Blood Clots in Orthopedic Surgery Fact Sheet (
  6. Total Knee Replacement Cost Without Insurance | Affordable Care in US (
  7. The Facts About Hip Replacement Cost | Outpatient Joint Replacement Center Of America (
  8. Hospital Stay of Orthopedic Cases in a Tertiary Care Hospital: A Descriptive Cross-sectional Study – PMC (
  9. AHA Annual Survey Database™ | AHA Data
  10. Readmissions after elective orthopedic surgery in a comprehensive co-management care system—a retrospective analysis – PMC (
  11. Patterns and Costs of 90-Day Readmission for Surgical and Medical Complications Following Total Hip and Knee Arthroplasty – PMC (
  12. What is Rapid Recovery Surgery? – North Central Surgical Hospital
  13. Enhanced Recovery After Surgery: a patient centered process – PMC (



Bernard Ross, CEO and founder, Sky Medical Technology

Bernard Ross is CEO and founder of Sky Medical Technology (Sky). Bernard is a serial entrepreneur with more than 20 years’ senior experience at private and public board level across multiple industries including pharmaceutical, technology development and FMCG. Bernard is a former Head of International Development at CMI plc, Senior Vice President, Cardiovascular of Bioaccelerate Inc. (BACL) and former CEO of Innacardio Inc.