Advantages Of Outpatient Total Knee Replacement
The advantages of the outpatient procedure include:
- Minimal surgical dissection
- Less blood loss during surgery
- Increased range of motion after surgery
- Less damage to surrounding tissues
Clinical Assistant Professor at Tufts University School of Medicine
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Outpatient Knee Replacement Surgery: Overview & Faqs
Total Knee replacements have come a long way. Previously patients stayed in hospital beds for weeks to recover only to then make their way into another physical therapy session. However, thanks to medical advancements, research, and technology, its now possible for patients to have same-day total knee replacement surgery. Using this approach, the surgery is performed but patients are not, admitted to a hospital.
There is a deeper understanding of the medical risks associated with surgery risks and thus associated complications can be better gauged and minimized. Medical research and technology advancements now enable medical professionals with the ability to identify patients for outpatient joint replacement surgery with a validated and consistent tool. This tool assesses a patients individual medical condition and determines if they are at low risk or high risk for outpatient joint replacement surgery. With this information, medical professionals can identify suitable patients. Proper patient selection is vital to reduce a patients risk of complications.
We at G2 Orthopedics and Sports Medicine believe in the power of knowledge and so we are sharing frequently asked questions to better help patients understand this new program and evaluate their options:
Q: What is an Outpatient Knee Replacement?A: An outpatient knee replacement, also called a same-day knee replacement the entire procedure and hospital stay lasts less than 24 hours.
Technical Details Of Total Knee Replacement
Total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection. This is followed by inflation of a tourniquet to prevent blood loss during the operation.
Next, a well-positioned skin incision–typically 6-7 in length though this varies with the patients size and the complexity of the knee problem–is made down the front of the knee and the knee joint is inspected.
Next, specialized alignment rods and cutting jigs are used to remove enough bone from the end of the femur , the top of the tibia , and the underside of the patella to allow placement of the joint replacement implants. Proper sizing and alignment of the implants, as well as balancing of the knee ligaments, all are critical for normal post-operative function and good pain relief. Again, these steps are complex and considerable experience in total knee replacement is required in order to make sure they are done reliably, case after case. Provisional implant components are placed without bone cement to make sure they fit well against the bones and are well aligned. At this time, good function–including full flexion , extension , and ligament balance–is verified.
Finally, the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement. The surgical incision is closed using stitches and staples.
Length of total knee replacement surgery
Pain and pain management
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Who Needs Knee Replacement Surgery
More than 600,000 knee replacement surgeries are performed each year, making it one of the most the most common orthopaedic surgeries in the U.S. The procedure relieves pain from osteoarthritis, which occurs when the protective cartilage in the knee breaks down with age or overuse. As a result, the bones rub together, which can eventually damage the knee joint.
Traditional knee replacement includes a hospital stay of up to three days. In recent years, surgeons found that some people do well without the hospitalization, thanks to new medicines that control bleeding, better pain management techniques, and physical therapy, which gets people up and walking soon after the surgery.
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.
This is made possible with recent advances such as improved perioperative anesthesia, minimally invasive techniques and initiation of rehabilitation protocols soon after surgery.
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Inclusion And Exclusion Criteria In The Selection Process
Inclusion criteria were written in English and focused on the comparison between outpatient and inpatient TKAs in terms of complication and readmission rates. When articles referred to the same database, only the study with more patients was included. Two authors independently selected the articles. Titles and abstracts were used for the first screening, and articles that were thought to be included in this study were then read by both authors. When the two authors disagreed on whether to include a study, consensus was reached by discussion and by consultation with a third reviewer . Review articles, meta-analyses, case reports, surgical technique articles, editorials, letters to the editor, preclinical studies, and studies not available in English were excluded. The PRISMA guidelines were used to conduct the study selection process .
When Outpatient Knee Replacement Is Safe
Most knee replacement surgeries require a stay at the hospital, especially if youre undergoing total knee replacement. A stay in the hospital allows Dr. Karas to more closely monitor your recovery and initiate physical therapy when you have the full support of the experienced medical staff. Dr. Karas does his best to get you home as quickly as possible.
However, if youre undergoing a partial knee replacement, its possible that Dr. Karas may let you go home the same day. When determining if its safe for you to go home the same day of your knee replacement surgery, he takes into consideration your overall health, age, and support system. How well you bounce back while youre in the surgical suite recovery room is also a factor that determines whether you can go home right away.
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Is The Person In Good Health
A candidate for outpatient knee replacement must be in overall good health. When evaluating overall health, the surgeon will consider existing medical conditions and other health factors, such as age and weight.
Existing medical conditionsPatients who have only mild disease or well-controlled conditions are typically eligible for same-day knee replacement surgery.
Patients who have more serious, uncontrolled, or multiple medical conditions may require monitoring in a hospital setting for 1 night or more. For example, chronic obstructive pulmonary disease, congestive heart failure, uncontrolled diabetes, morbid obesity, kidney failure, and cirrhosis of the liver are associated with increased risk of post-surgical complications.
Other health factorsBelow are other health factors that a surgeon will consider:
How Might I Benefit From Having An Outpatient Total Knee Replacement
While inpatient surgery is still the most common approach to this procedure, it’s no secret that outpatient options are growing in popularity. This is due to benefits such as the ones that are listed below:
- Affordability is embraced by delivering decreased costs.
In an outpatient setting, surgery costs are usually more affordable for patients. It is not only due to a decreased amount of time a patient must be under observation, but more refined processes that still provide quality treatment while minimizing expenses. Keep in mind that knee replacement surgery is the same within both settings, so there is no exposure to risk or a lower level of care.
- Less risk of post-surgical infections and other complications.
A study was done by the University of Iowa Hospitals and Clinics that has shown that complications are more common for those who underwent knee replacement surgery and have a hospital stay of 3 days or more. Whereas same-day surgery options provide a lesser risk of both complications as well as post-surgical infections. This has a lot to do with the difference in approaches between the two.
- Recovery can be shorter and more comfortable at home.
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What Is An Outpatient Knee Replacement
An outpatient knee replacement and a traditional knee replacement are carried out the same. The procedure itself will be identical to a hospital replacement. The differences in an outpatient surgery lies in the pre-op preparation, the length of hospital stay, and the location of post-op recovery.
In a total knee replacement the cartilage and bone that have been damaged are removed. Your healthy bone and cartilage are resurfaced and left to support the artificial components that will be implanted. A total knee prosthesis is comprised of 3 parts. These components are usually made of metal with a plastic insert. In short, during a knee replacement all knee joint damage will be removed, the healthy joint will be resurfaced and the different parts of your prosthesis will be put in place.
To read about the implant materials, manufacturers and styles, check out article Different Types of Knee Replacement Implants.
The end result of knee replacement surgery is a new joint that is rid of your diseased bone and cartilage. In its place are artificial man-made parts that afford you greater function and mobility, and less pain than your natural, troubled joint.
Is Outpatient Tka Safe
Outpatient TKA has been shown to be safe, has a low rate of hospital readmission and is economically advantageous. In fact, clinical results as good as those obtained in hospitalized patients have been reported. In 2018 Shah et al reported that outpatient total joint arthroplasty with discharge to home at a freestanding, independent ambulatory surgical centres is a safe option after development of a multidisciplinary TJA pathway.
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Similar Conditions That Affect The Knee
Sometimes patients with knee pain don’t have arthritis at all. Each knee has two rings of cartilage called “menisci” . The menisci work similarly to shock absorbers in a car.
Menisci may be torn acutely in a fall or as the result of other trauma or they may develop degenerative tears from wear-and-tear over many years. Patients with meniscus tears experience pain along the inside or outside of the knee. Sometimes the pain is worse with deep squatting or twisting. Popping and locking of the knee are also occasional symptoms of meniscus tears.
Since some of these symptoms may be present with arthritis and the treatment of arthritis is different from that of meniscus tears, it is important to make the correct diagnosis. A good orthopedic surgeon can distinguish the two conditions by taking a thorough history, performing a careful physical examination, and by obtaining imaging tests. X-rays and Magnetic Resonance Imaging scans may be helpful in distinguishing these two conditions.
Knee Joint Infections
Also called infectious arthritis or septic arthritis, a joint infection is a severe problem that requires emergent medical attention. If not treated promptly knee infections can cause rapid destruction of the joint. In the worst cases they can become life-threatening.Symptoms of a knee joint infection include:
- severe pain
- fevers and
Again, a joint infection is a serious condition that requires immediate medical attention.
What Is The Persons Home Living Situation
A surgeon will ask questions about the patients home living situation, including questions about:
- Live-in support. Just as with discharge from a hospital in-patient stay after joint replacement, family, friends, or hired support will be needed for household help, meals, and transportation for the first few days or weeks after surgery. Ask your surgeon about transportation assistance, as there are often simple solutions to assist with transportation to physical therapy or follow-up visits.
- Pets. Pets can get underfoot, and a cat toy or dog bed can be a tripping hazard. It is encouraged to board pets for the first few weeks after joint replacement to minimize fall risk.
- Stairs. Patients will be educated on how to safely navigate stairs after surgery. In some cases, a pre-operative home visit can be pre-arranged to help prepare for an individuals unique situation. Patients are advised to let their surgeons know if they have unusual living situations.
- Sleeping situation. Ideally, the bed is easy to access. In addition to stairs, the bedroom layout and the height of the bed may be considered.
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Am I A Candidate For Outpatient Knee Replacement
Dr. Michael Bolognesi said several factors determine who may benefit from outpatient knee replacement surgery. The most important criterion is that that the person is in overall good health. Age is less of a factor. Someone in their 70s with no other health problems could probably do as well as someone in their 50s, Dr. Bolognesi said. People with other medical conditions, such as high blood pressure or diabetes, are less likely to be good candidates if these diseases are not well managed.
When deciding who stays in the hospital and who goes home right away, Dr. Bolognesi said he evaluates how well the patient is doing after their surgery, including whether they will be safe at home and have someone there who can provide support. Also, their pain must be under control by the time they leave the hospital.
Candidates for outpatient knee replacement also must meet another important requirement: a commitment to success. They must buy-in to the process, Dr. Bolognesi said. That positive attitude can motivate them to follow post-op instructions correctly and identify problems quickly. It can also help ensure that they follow up with their caregivers for scheduled calls or visits.
When Is Outpatient Total Knee Replacement Suggested
Outpatient total knee replacement is considered when your vital signs are stable, such as heart and respiratory rate, blood pressure, and temperature. Moreover, you need to be able to maintain pain control with oral medication and tolerate a regular diet before being discharged on the same day of surgery.
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A Few Days In The Hospital
In the past, patients stayed an excess of 10 days in post-operative care. Now, patients stay for just a few hours or days after the operation. During the time, the doctor occasionally observes the knee while checking for possible infections. Around this time, a physical therapist may visit the patient to create a therapy plan. Inpatient surgery is useful for observation, treating any complications, and dealing with the patients mobility.
Characteristics Of Severe Arthritis Of The Knee
Pain is the most noticeable symptom of knee arthritis. In most patients the knee pain gradually gets worse over time but sometimes has more sudden flares where the symptoms get acutely severe. The pain is almost always worsened by weight-bearing and activity. In some patients the knee pain becomes severe enough to limit even routine daily activities.
Morning stiffness is present in certain types of arthritis. Patients with morning stiffness of the knee may notice some improvement in knee flexibility over the course of the day. Rheumatoid arthritis patients may experience more frequent morning stiffness than patients with osteoarthritis.
Swelling and warmth
Patients with arthritis sometimes will notice swelling and warmth of the knee. If the swelling and warmth are excessive and are associated with severe pain, inability to bend the knee, and difficulty with weight-bearing, those signs might represent an infection. Such severe symptoms require immediate medical attention. Joint infection of the knee is discussed below.
The knee joint has three compartments that can be involved with arthritis . Most patients have both symptoms and findings on X-rays that suggest involvement of two or more of these compartments for example, pain on the lateral side and beneath the kneecap . Patients who have arthritis in two or all three compartments, and who decide to get surgery, most often will undergo total knee replacement .
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Who Should Consider Total Knee Replacement Surgery
It is usually reasonable to try a number of non-operative interventions before considering knee replacement surgery of any type. Prior to surgery an orthopedic surgeon may offer medications knee injections or exercises. A surgeon may talk to patients about activity modification weight loss or use of a cane.
The decision to undergo the total knee replacement is a “quality of life” choice. Patients typically have the procedure when they find themselves avoiding activities that they used to enjoy because of knee pain. When basic activities of daily life–like walking shopping or reasonable recreational pastimes–are inhibited or prevented by the knee pain it may be reasonable to consider the surgery.
What To Expect After Outpatient Total Knee Replacement
Several hours after surgery, you will be discharged from the hospital following a thorough examination to make sure you meet the requirements for discharge such as stable vital signs during exercise, ability to eat and take pain medicine by mouth. You generally have a two- to four-week recovery compared to the two-to-three-months needed to recover from traditional knee surgery.
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Less Risk Of Complications And No Hospital Stay
Another benefit of same-day knee replacement is less blood loss occurs from a smaller incision, which minimizes the risk of surgical complications. Youll most likely experience less pain and a more rapid return to your usual activities than if you had to spend several days in the hospital.
Minimally invasive, same-day knee replacement surgery requires advanced training and specially designed surgical tools. The orthopedic surgeons at Orthocenter have the training and experience needed to expertly perform this outpatient procedure, giving you peace of mind that youre receiving the highest standard of care. Its their goal to get you back to living your active lifestyle as quickly as possible, with the elite-level medical practices for which theyre known.
If youve been considering replacing your knee because of osteoarthritis, an old sports injury, or another degenerative joint condition, but you dont want to endure a lengthy hospital stay and recovery period, same-day, outpatient knee replacement surgery may be ideal.
To learn if youre a candidate for outpatient knee surgery, call the Orthocenter New Jersey office thats closest to you, or request an appointment for a consultation using the convenient online booking tool.
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