Total Joint Program

Through a combination of minimally invasive surgical techniques, regional anesthesia, and a state of the art facility, the patients are able to get out of bed and participate with physical therapy hours after their surgeries and recover in their own homes.

For More Information

For Existing Patients requiring more information please contact our Patient Care Coordinator by calling 415-659-3176 or email at

For Prospective Patients or Surgeons please call Jessie Scott at 415-659-3141 or email at

Total Joint Program

Joint Replacements in an Outpatient Setting

The surgical population for joint replacements is getting younger. Patients are interested in getting home as soon as possible, and returning to as high an activity level as possible.

One of the biggest postoperative challenges for patients undergoing total knee,  hip or shoulder replacements is pain. Historically, pain has kept patients in the hospital on an average of two to three days. Pain limits patients ability to participate in physical therapy, and has led to longer hospital stays.

Presidio Surgery Center has developed a comprehensive protocol that allows motivated patients to have their total hip, knee or shoulder replacement done in an outpatient setting and go home the following morning.

Through a combination of minimally invasive surgical techniques, regional anesthesia, and a state of the art facility, the patients are able to get out of bed and participate with physical therapy hours after their surgeries, and recover in their own homes.

Newer Techniques for a Better and Faster Recovery

Our patients have extremely high satisfaction with the rapid recovery protocol.  It’s better for the patient to go home as soon as possible. The hospital environment can be counterproductive for healing. Hospital acquired infections are a reality, and the longer a patient stays in the hospital environment, the higher the chance is for a post-operative infection. Moreover, complications such as blood clots are lessened if patients are allowed to get out bed and walk.

Newer anesthetic techniques have revolutionized hip, knee  and shoulder replacement. Patients receive a regional anesthetic, similar to a local anesthetic, and then are placed into a twilight sleep. This allows patients to avoid undergoing a general anesthesia and lessens complications such as post-operative nausea, vomiting, and confusion. Immediately after surgery, our patients are awake, alert and ready to participate in physical therapy. Presidio also uses a time-released local anesthetic that lasts 48 hours, the time period where patients’ pain is most intense. There is an emphasis on using non-narcotic pain relievers like intravenous anti-inflammatories and Tylenol. Intravenous narcotics are counter-productive to recovery. They will lower blood pressure, increase nausea/vomiting, lessen the desire to get out bed, are constipating, and slow the recovery process.

Credentialed Surgeons Focused on Accurate Reconstruction

Presidio’s credentialed surgeons use advanced minimally invasive surgical techniques, where they focus on accurate reconstruction of the joint. All incisions are closed with absorbable sutures, so there are no staples or sutures to remove. Patients are healing faster and their surgeons are seeing them at two weeks out of surgery at a level of mobility that usually took three months for both hip and knee replacements.

Hip and Knee patients receive outpatient physical therapy usually starting in their home and then transition to outpatient physical therapy in 1-2 weeks.

Complete Care From Start to Finish

Presidio is  not interested in just doing surgery. We are interested in the complete care of the patient from surgery through recovery. Our patients that have undergone rapid recovery total joint replacement are routinely more satisfied than those that have undergone traditional joint replacement. As one patient said, ‘why would anyone do it differently?’”.

Not every patient is a candidate for ambulatory surgery. It depends on the home situation and other underlying medical problems. For a consultation to see if you would qualify for our program, please contact one of our program physicians.

Glowing Patient Referrals

Bill Stock

Dr. Mayle:

Here is a picture of me at the Ama Dablam Basecamp a couple of weeks ago. The picture was taken at about 16,000 feet in elevation and a few miles from Mt Everest and Lohtse.

This was about seven months after you and your team did a total knee replacement on my right knee. The new joint was working great on this two week trek.  We have also done some significant hiking in Japan and China.

Thanks to you and your team for helping me have the adventure of a lifetime.  I will send more pictures from the Andes in September.

Bill Stock

Brion Dunbar

Dr. Mayle,

Thank you for your skill and care.

Brion Dunbar

Hip Replacement Surgery: May 25, 2016
Snowman Trek in Bhutan: September 26 – October 26, 2016
Photo taken 17,600 Feet
Trek Length: 22 Days
Total Hiking Distance: 180 Miles

National Joint Commission Approved

We are the first facility in California to receive the Advanced Certification in Hip and Knee Replacement. This certification is recognized nationwide as a symbol of the highest standard in quality and reflects our commitment to meeting the highest of standards in performance.