This post was co-authored by Grace McClure and Dr. Nicholas Frisch)
Outpatient knee replacement surgery—what will it look like? Is total knee replacement outpatient? What can I expect during my 24 hour (or less) stay at an outpatient center? How is same-day joint surgery different from regular, inpatient surgery? These questions are all common for patients awaiting or considering an outpatient knee replacement.
Knowing what to expect on surgery day for any surgery allows you to feel better prepared and reduces stress and anxiety. This is especially true for an outpatient knee replacement as it is less common and there are fewer accounts of what the procedure actually entails.
What is an outpatient knee replacement? An outpatient knee replacement, also called a “same-day knee replacement” means that the entire procedure and hospital stay lasts less than 24 hours. Outpatient knee replacement surgery is not for everyone, but is sometimes preferred amongst patients and especially surgeons.
Read on as we breakdown the benefits to outpatient knee replacement surgery, and what to expect for the procedure and during your brief hospital stay.
Fact: Experts predict that within the next decade more than half of all joint replacements will be performed in an outpatient setting.
What are the Benefits of Outpatient Knee Replacement (TKR)?
- More advanced care. Since outpatient centers are newer, these ambulatory facilities tend to be more technologically advanced. These centers tend to be run by innovative surgeons who practice with orthopedics “latest and greatest” techniques. In other words, you won’t be operated on by a dinosaur in a cave with dated techniques (kidding).
- A greater focus on pre-op preparation. The more mentally, physically, and environmentally prepared you are for surgery, the lower your risk, the better your outcome, and faster your recovery. Outpatient surgery centers tend to invest more in prehab and encouraging patients to go into surgery with their “best foot forward”.
- Higher patient satisfaction. Studies suggest outpatient joint patients are more satisfied with their replacement and the care they’ve received. Other studies found that staying longer (or shorter) in hospital is not what affects patient satisfaction.
- Lower rates of infection. The shorter the stay in a care facility, the lower the risk of hospital infections.
- Recover at-home. You can recovery in your own space where you are comfortable
Dr. Frisch explains, “By going home the same day, you are really committing to using your new knee immediately. The result is that you start walking and performing your daily activities sooner than if you were to stay in the hospital. With the right preparation you will start to see the results and become more confident in your knee.”
To be a candidate for same-day knee surgery, patients must: be well-prepared, be in good overall health without any secondary diseases, have no added risk-factors, and have a support system at-home to assist in their recovery.
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 (outpatient or inpatient) 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 (buffered up and prepped for the implant) 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.
Step-by-Step Guide to a Same-Day Knee Replacement
Dr. Frisch explains that “total knee replacement can be safely performed in the outpatient setting on the right patients. I’ve found that the sooner you start walking on your new knee, bending it and performing your normal daily activities, the quicker it starts to feel ‘normal’. This will be different for everyone, but by being at home you can begin to get into your routine and once you do you will see positive strides in your recovery.”
1. Pre-Op Preparation
Before outpatient knee replacement surgery, it’s imperative that you’ve been vetted by your surgeon as a patient who fits the criteria for a same-day surgery. This means that you have a healthy BMI, are low-risk, have a comfortable at-home environment to recover in, have support and so forth.
If a same-day surgery has been recommended, it’s absolutely imperative that you walk into surgery day feeling prepared, healthy, and strong. Patients who are better prepared for surgery are lower risk and recover faster and safer at home. Your outpatient center should not just host a pre-op education class for you and your caregiver, but should offer a PreHab program that actively engages and prepares you for surgery. A complete Prehab program, like PeerWell’s mobile PreHab platform, will count you down to surgery. The program will share lessons, exercises, pain management techniques (and more) for you to complete each day to get the most ready possible.
Getting prepared outpatient surgery means:
- Getting physically prepared by improving pre-op range of motion, building supporting muscle strength etc.,
- Lowering risks by controlling what you can. This means losing extra weight, eating foods that lower blood pressure, taking a smoking “time out” etc.
- Becoming mentally prepared by learning ways to control anxiety, let go of negative thoughts, and minimize unnecessary stress.
- Helping you take care of “housekeeping” like organizing your home, packing for the hospital, getting your caretaker ready etc.
2. Surgery Day
Once you are admitted to the outpatient center, your “express knee replacement” experience begins. Before surgery, all of your vital signs will be checked. This means blood pressure, heart rate etc. When everything is measured and checks out, your surgeon will enter the room and mark up your surgical leg for the incision. Next, you and your surgeon’s preferred anesthesia (regional or general) will be administered. Once you are sedated or unconscious, surgery begins!
What’s involved in the procedure:
- Incision is made- Depending on your approach (minimally invasive or traditional), an incision between 4-10 inches is made across the front of your knee. The cut gives your surgeon visibility and access to behind your kneecap (patella).
- Knee is opened-up- Like a book cover, your kneecap is flipped open. This is where your knee will be resurfaced and where all of the components will be implanted.
- Femur Component- Your upper thigh bone (femur) is resurfaced. All of the damaged cartilage and diseased bone is cut out. The healthy bone is reshaped to fit the femoral implant. The femoral component (the largest of the pieces) is “press fit” (cementless) or cemented into place.
- Tibia Component- The damaged cartilage and any diseased bone is removed. The healthy bone is shaped to fit the tibial part. This implant is usually attached using bone cement.
- Plastic Spacer Component- With the femoral and tibial parts attached, a plastic insert is snapped into place between them. This flexible plastic spacer lets your knee joint bend and flex along its smooth surface.
- Patellar Component- Not everyone has their kneecap resurfaced. If the kneecap is damaged and needs to be resurfaced, a dome-shaped patellar component that acts as a “new kneecap” will be cemented in place.
- Test- Once everything is in place, your surgeon will move and bend your leg to test the flexibility and movement of your implant. When your surgeon is confident in your range of motion, the incision will be closed up and bandaged.
3. After Surgery
Average time from admission to discharge is 375 minutes (6.25 hours) for total hip replacements and 426 minutes (7.1 hours) for total knee replacements.
After surgery, you will wake-up and likely meet with your surgeon, nurses, a physical therapist (or occupational therapist) and maybe even a social worker. Your care team will share how your surgery went and prepare you for a discharge straight home. They will give you the information you need for taking pain medication, schedule your at-home physical therapy, and provide other materials to help you recover.
If there are any medical concerns or complications (which there is a very, very low chance of) they will keep you longer or transfer you to a traditional inpatient facility or a secondary care facility (rehab). Almost all same-day patients will be discharged straight home. Going home after an outpatient surgery is always the aim.
A study published in Healio reported that 50 of 51 patients (98.0%) were discharged straight home after outpatient total joint surgery. In the same study, the average discharge time was just 176 minutes after surgery (about 3 hours).
Once you’re home, it’s important to actively engage in a complete ReHab program like PeerWell. Similarly to PreHab, PeerWell’s ReHab program will guide you through the exercises, lessons, meditations, and helpful tips to recover faster and safer. Simply doing physical therapy a couple of times a week and taking your pain medication will not be enough to achieve the “bounce back” you want.
PeerWell’s ReHab program will help you:
- Feel supported and proactive in your recovery with straightforward daily tasks to complete
- Recovery faster, better and safer.
- Rebuild strength, motion, flexion, and extension in the muscles surrounding your joint
- Regain normal movement in your joint
- Better deal with pain
- Monitor and avoid post-op complications
- Track and measure your improvement (e.g. with the in-app knee flexion measurement tool)
Get matched to a top orthopedic surgeon for an inpatient or outpatient replacement. We will match you with a surgeon in your area who offers PeerWell’s PreHab & ReHab program for free! With PreHab (followed by ReHab) you will recover faster, better and safer from your replacement.
Dr. Nicholas Frisch, M.D., OS, MBA is an award-winning orthopedic surgeon based out of Rochester, Michigan. He focuses on minimally invasive joint replacement surgery and complex revisions. Dr. Frisch completed his residency at Henry Ford Hospital in Detroit and his Adult Reconstruction Fellowship at Rush University Medical Center in Chicago. Dr. Frisch is has won Orthopedics Best Clinical Article Award, the AAHKS Healthcare Policy Fellowship, Outstanding Resident Award Henry Ford Hospital, the Ford Motor Co. Connected Health Challenge, and more.