Home by Nightfall: How Missoula Bone & Joint Is Changing Joint Replacement

"Joint replacement in 2026 is exciting," says Dr. Cameron Barton, Cam for short. Dr. Barton, who performs these operations at the center, is a board-certified, fellowship-trained orthopedic surgeon who specializes in hip and knee replacement at Missoula Bone & Joint. The reason is that the surgery is now built around what he calls a "rapid recovery" approach. Patients, he says, "can spend as little as 5-8 hours in the surgery center." While some patients, especially those facing long drives, may still need to stay the night, being able to go home is becoming more and more the norm.

Speaking of long drives, patients really do come from Idaho, Wyoming, Canada, and, of course, from all over Montana to visit Missoula Bone & Joint Surgery Center. "We are very thankful that these patients choose us for their joint replacement," Barton says. Presumably they could receive those treatments closer to home, but choose MBJ because that's where they receive the finest care.

A day at the surgery center follows what Dr. Barton describes as "a predictable and carefully planned flow." Much of the anxiety that once came with that morning is no longer a factor. Most patients attend a pre-op education class a week or two beforehand, so that by the time they arrive, they already know what to expect: check-in, a surgical gown, skin preparation, IV access, pre-op medications, and a conversation with the anesthesiologist.

A joint replacement surgery, according to Dr. Barton, "typically takes an hour to hour and a half from the actual skin incision to placement of the postop bandage immediately after surgery." After that, the patient returns to recovery and waits for the anesthesia to wear off, carefully monitored by nurses. "Once patients meet the appropriate criteria, such as pain control, stable blood pressure, and safe mobility, they are discharged with follow-up appointments already scheduled," Barton explains.

This is a rapidly developing field, and staying on top of it means embracing new solutions to old problems. One of the most dramatic changes has been in the treatment of pain. "I honestly can't believe that patients can undergo a full joint replacement and recover with little to no narcotic medications," he says. "Just 5-10 years ago it was relatively common for patients to stay multiple days in the hospital, sometimes just for pain control... The fact that some patients only need a few doses, or sometimes no narcotics at all, makes the patients, surgeons, anesthesiologists, and employees at Missoula Bone & Joint very happy."

Improvements in surgical technique made the process less invasive, with many modern hip and knee replacements performed through "muscle-sparing" approaches that preserve the patients' strength and work to reduce pain during the early stages of healing. MBJ also employs what Dr. Barton calls a "multi-modal approach to pain." This, he told us, means "rather than just relying on strong narcotic pain meds, we utilize a pain control approach that acts through several pathways. We utilize nerve blocks such as the adductor canal block and spinal blocks, as well as a periarticular joint block that is administered during surgery. We also prescribe and administer pain medications that work on alternative pathways to narcotics."

In addition to non-opioid solutions like anti-inflammatories, a muscle relaxer, and acetaminophen, many patients "opt for a new medication that we have found to drastically reduce need for narcotics that work through blocking sodium channels to reduce pain." Barton adds, with a note of well-deserved pride, that "I personally have seen many patients get through the whole joint replacement recovery without any narcotics."

Another important innovation is the use of robotic assistance and surgical navigation. The way they help the patient, Dr. Barton told us, is by working to improve the longevity and function of the replacement.

"When a knee replacement is aligned and balanced correctly, it potentially improves the function and longevity of the replacement. Research has shown this is particularly true for partial knee replacements, where these seem to last longer when performed with robotic or navigation technology." Dr. Barton notes that "currently we have multiple different robotic technologies we can utilize if needed to perform the best joint replacement possible."

Naturally, longevity matters to Montanans, well-known for their incapacity to stay down for long. "Patients are asking to do all kinds of very active things around Montana. They want to continue to ski and hunt and hike. By performing a well-balanced, perfectly sized, and functionally or kinematically aligned knee replacement, I believe this gives our patients the best chance at getting back to the activities they love."

His favorite outcomes, he says, are the ones where patients return to the clinic and tell him the surgery "completely changed their life," often adding that they wish they had done it sooner.

When it comes to the bill, MBJ offers bundled payments, which Barton tells us "potentially decreases cost for the patient and helps avoid big surprises in their final bill. At Missoula Bone & Joint, we strive to keep patients informed about what to expect for out-of-pocket costs. Our billing team gets pre-approval from insurance companies to ensure the joint replacement is covered for elective joint replacement. They also provide a cost estimate for out-of-pocket costs including insurance deductible or all-in costs for self-pay bundles. We also," he adds, "offer bundles for self-insured employers."

Talking to Dr. Barton, it is clear that he enjoys his job, and that patients at Missoula Bone and Joint should know they are in very good hands, whether it is Dr. Barton or one of their other physicians who treats them. But they all share the same sense of satisfaction as Dr. Barton when he tells us, "Hearing patients say that they finally got to hike in Glacier National Park, or ride on the Hiawatha Trail, or were able to get that elk this season, brings a smile to my face."

In short, he says, "that's what this work is all about."