Outpatient Knee Replacement
Going back just 10-15 years ago it was quite common for a patient to spend nearly a week in a hospital setting after undergoing total knee replacement surgery. There were many reasons for this prolonged hospital stay. First, most knee replacement surgery at that time was done via a traditional extended incisions which involves significant violation of the tendons/muscles of the front of the knee and typically takes longer to recover from. Physical therapy often did not begin until 24-48 hours after surgery which meant lost time directly after surgery. Blood conservation strategies were not fully implemented meaning that many patients did require postoperative blood transfusions. Finally, anesthetic pain control pathways did not always do a great job in limiting post-surgical pain. The result of this was that most patients spent many days hospitalized after hip replacement.
Fortunately, in the last decade there have been marked improvements in the patient experience when undergoing knee replacement surgery. Many surgeons who are experts in knee replacement now perform the SubV (subvastus) Knee which is a minimally invasive approach to knee replacement that is performed without cutting any muscle or tendon. The result of this is that SubV Knee patients tend to have less pain, better strength, and quicker recovery after surgery compared to more traditional methods. Physical therapy is now getting knee replacement patients up and walking within 1-2 hours after surgery. Use of medications during surgery that help limit blood loss in the knee have reduced the risk of needing transfusions to an almost negligible rate while anesthetic pain control has improved by leaps and bounds with the use of preoperative regional nerve blocks. The anesthesia team now performs multiple pain-relieving blocks of the nerves around the knee in the preop area before the patient even gets in the operating room. Further, more and more knee replacements are being performed by extremely high-volume surgeons who specialize solely in joint replacement surgery and can offer better results to patients. All these factors have led to a growing trend of knee replacement surgery being performed in an outpatient setting with patients able to mobilize quickly after surgery and go home the same day.
Most outpatient knee replacements are performed at an Ambulatory Surgery Center (ASC). These are free standing surgical facilities that usually highly specialized for certain types of procedures. The anesthesia team members are very experienced as are the surgical staff. Patients arrive approximately an hour before surgery and are typically home within a few hours after the procedure. Physical therapy is provided for all patients after surgery. Before a patient is discharged home there must be proven ability to safely walk independently with a walker, climb stairs with minimal assistance, get to and from the restroom, and have excellent pain control. Only then is the patient discharged to home.
In order to be a candidate for outpatient knee replacement patients must meet certain health and activity requirements. Patients should not have any active cardiopulmonary disease. For patients with a remote history of problems a request for cardiac clearance may be made through the treating Cardiologist. Patients should have a Body Mass Index (BMI) of under 40 and should be able to ambulate independently at home. Finally, a good patient candidate for outpatient knee replacement should be motivated to recover quickly and be willing to work with physical therapy. Given these paraments, most patients undergoing knee replacement are in fact candidates to have this surgery performed in the outpatient setting.
Why choose outpatient Knee Replacement?
There are many reasons why more and more patients are electing to have knee replacement in an outpatient ASC setting. The chief reason is that most patients would rather recover at home as opposed to spending days in a hospital bed. Recovery at home means less disruption of day-to-day activities versus being hospitalized. It allows patients to better control pain by using pain medication as needed. Patients are also more able to interact with family members and friends. Along with the convenience of recovering from home there are also many other reasons patients may want to consider outpatient surgery. Surgery in the ASC setting is thought to have lower risk of infection and lower chance for blood clots. Most orthopedic ASCs do not perform surgery on patients known to have infections so therefore there are no “dirty” cases being performed in the same rooms as joint replacement surgery. Getting patients up and walking directly after surgery is commonly accepted as once of the best ways to reduce the risk of blood clots. Patient satisfaction rates at OrthoVirginia have consistently been higher with outpatient ASC joint replacement as compared to more traditional hospitalization after surgery. Finally, in most cases surgery in an ASC setting results in significant financial savings as compared to an inpatient hospital setting.
Next Steps
If you would like to learn more about outpatient joint replacement surgery please set up an appointment to discuss options. Dr Wind performs more outpatient hip and knee replacement surgery than any other surgeon in central Virginia. He has a proven record of providing safe and effective joint replacement surgery to his patients with reliably excellent results. He performs outpatient hip and knee surgery at the Boulders Ambulator Surgery Center as well as the OrthoVirginia Westchester Ambulatory Surgery Center where he also serves as the Medical Director. He is always happy to discuss all options and make sure that the patient is informed and comfortable with his/her decisions.
