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Digital Issues

Archive >  June, 2013 XIV, No. 6

Secrets to Success in Outpatient Knee Replacement

Patients will walk out of your facility a few hours after they limped in.

Richard Berger, MD

knee surgery STRAIGHT LEGGED Perform partial and total knees with the knee in extension, so the quadriceps remains lax.

Why is sending knee arthroplasty patients home the day of surgery considered the future of joint replacement? I've been doing outpatient total and partial knee replacement to treat degenerative arthritis for more than a decade, pioneering the surgical technique and perfecting management of post-op pain, PONV prevention and DVT prophylaxis. More surgeons and facility leaders are realizing the procedure can be done safely and efficiently in ambulatory settings. They're right, as long as every aspect of patient care, from pre-op to PACU, is performed perfectly.

Everyone's a candidate
Outpatient knee replacement is suitable for most any patient healthy enough for surgery, so we don't deny many patients the care they seek. In fact, I recently operated on a 93-year-old man who went home the same day.

We typically perform 8 knee arthroplasties in a day. Patients who undergo surgery at 7 a.m. are usually ready for discharge between noon and 1 p.m. Those operated on in the early afternoon head home between 5 p.m. and 6 p.m. My hospital mandates that patients must get in and out of bed without nurse assistance, and walk up and down a hallway and stairs by themselves before being released. (Patients complete brief post-op consultations with a physical therapist before being cleared for discharge.) Most patients go home without need of a cane; we give some crutches or, rarely, a walker.

It's critically important to set the expectations of patients and their escorts for same-day discharge. My minimally invasive replacement technique is really a minor procedure, so there's no reason most patients shouldn't be able to go home a few hours after surgery. They and their loved ones need to realize and expect that. They'll be up and walking in PACU. They'll be comfortable and medically stable. They'll be ready to go home after a short stay in recovery. But if unforeseen medical issues arise during the recovery phase or they can't move around by themselves — rare occurrences in my experience — we'll keep them as long as needed, until they're ready for appropriate and safe discharges.

 
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