What is Outpatient Total Knee Replacement?
Total knee replacement is the surgical treatment for knee arthritis, where the damaged knee is removed and replaced with an artificial knee implant. Traditionally performed as an inpatient procedure, total knee replacement surgery is now being conducted on an outpatient basis, allowing you to go home on the same day of the surgery.
Who is a Candidate for Outpatient Total Knee Replacement?
Outpatient total knee replacement is considered for healthy patients with minimal pre-existing medical issues. The procedure is performed at Palm Beach Surgical Suites, an outpatient surgical center, and patients are discharged to home the same day. It is important to have a family member or other individual stay with you during your early recovery.
Not all patients are candidates for outpatient surgery. The criteria required to qualify for an outpatient total knee replacement, include:
- Being fit and in general good health
- Motivated with a positive frame of mind
- Maintains a normal weight
- Knee condition that has failed conservative management
- A good network of family and friends who can provide care during recovery
- Commitment and preparedness to strictly adhere to doctor’s post-surgery instructions
- Mobile, active, and independent prior to surgery
Outpatient Total Knee Replacement Procedure
The outpatient procedure is performed using advancements in anesthetic techniques like a spinal anesthetic and an adductor canal block that produces a centralized anesthetic effect and does not require a hospital stay for its effects to wear off, like traditional general anesthesia.
You will be lying on your back on the operating table and a tourniquet is applied to your upper thigh to reduce blood loss. The arthritic knee is approached using less invasive techniques. The damaged portions of the femur (thighbone) are trimmed at appropriate angles using specialized jigs and special guides to ensure a perfect fit of the implant. The next step involves the removal of the damaged area of the tibia (shinbone) and the backside of the kneecap.
The femoral component is attached to the end of the femur with bone cement. The tibial component is then secured to the end of the bone using bone cement. Your surgeon places a polyethylene liner that acts as an articular surface between the thighbone and shin implants and the back of the kneecap to ensure smooth gliding movement. With all the components in place, the knee joint is examined for range of motion.
All excess cement is removed and the entire joint is cleaned out with a sterile saline solution to prevent infection. Drains are inserted if necessary and the incision is closed. A surgical dressing or bandage is placed. The whole process takes just over an hour.
Postoperative Care and Instructions after Outpatient Joint Replacement
After surgery, you will spend the next several hours in the recovery room where you be monitored for vital signs, pain control, and the ability to eat and take pain medicine by mouth. The nursing staff will ensure that you can walk safely with a walker as well as use the restroom. An x-ray will be performed prior to your departure. Once you’re home, a home health nurse and physical therapist will come to your house to start your rehab program.
You will be given a pain control protocol to ease pain. Compression stockings are recommended to prevent blood pooling in your legs. You will be able to do light activities within a couple of weeks. You will also be given postoperative instructions, such as:
- Use of assistive devices for walking, such as walker followed by a cane
- Suture and dressing care
- Physical therapy and exercise regimen to improve walking, range of motion and strengthen muscles
- Shower instructions
- Adherence to prescribed medications
- Adherence to follow-up appointments
Benefits of Outpatient Surgery
As it is an outpatient surgery, you will be discharged home the same day after your anesthesia wears off. Recovering from home means leaving the hospital setting and getting to recuperate in the comfort of your own home. You will progress better in a familiar home environment where you are more likely to receive good care and a good night’s sleep.
Some of the benefits of outpatient surgery include:
- Less pain: Outpatient surgery does not involve a pain pump for self-administered medications or IV pain medicines.
- Fewer transfusions: Patients are less likely to require blood transfusions due to improved surgical techniques involved with outpatient surgery.
- Convenience: The convenience of recovering in your home generally makes recovery time easier than in an inpatient setting.
- Lower cost: Since there are no hospital room charges and related hospital charges, costs are much lower with recovery at home.
- Better recovery: You feel isolated in a hospital setting due to lack of social interaction that negatively affects your recovery. You will recover better in a home setting with care and interaction from your family and friends.
- Safer: Home recovery is much safer compared to a hospital stay as you are at risk of developing a hospital-acquired infection (HAI) in a hospital setting, no matter how sterile a hospital environment is.
Risks and Possible Complications of Outpatient Total Knee Replacement
Outpatient knee replacement is a relatively safe procedure; however, as with any surgery, it does carry some risks, such as:
- Blood clots
- Infection
- Bleeding
- Injury to nerves and blood vessels
- Stiffness of the knee due to scar tissue
- Joint loosening