Same Day Knee Replacement
Chronic knee pain from osteoarthritis can make it almost impossible to complete even the simplest everyday activities like walking to the mailbox or taking care of small chores around the house. When pain doesn’t respond to medications or physical therapy, one of the most common solutions is knee replacement surgery. The good news is that advances in technology have made it possible for the procedure to be completed in a single day. Today, board-certified orthopedic surgeon Dr. Joseph L. Finstein answers some common questions that patients may have about same day knee replacement.
Q: What has made same day knee replacement the preferred surgical method?
A: The primary reason we’ve gone from patients staying in the hospital multiple days to same day knee replacement is due to the incredible improvements in medical technology, surgical techniques, and medications.
The medications that are given before, during and after the procedure, the nerve blocks that we use, new surgical techniques have all improved. Robotic assisted surgery allows us to perform the surgery with more precision and smaller incisions than ever before. The robotic arm assisted surgery means now we can protect more soft tissue, ligament, and healthy bone than we could with the old, manual surgical techniques.
"Now we can protect more soft tissue, ligament, and healthy bone than we could with the old, manual surgical techniques."
- Joseph L. Finstein, MD
Q: What are the advantages of an outpatient knee replacement over older techniques?
A: One advantage that’s obviously important as we deal with COVID-19 is that having a same day knee replacement means less exposure to people while you’re in the hospital and less risk of exposure to any type of infection. It gets people home where they’re most comfortable to recover and where they have family members around to support and help. With COVID, family members would not be allowed with the patient in the hospital.
Q: Who is a good candidate for outpatient knee replacement?
A: Basically anyone with arthritis who needs a knee replacement, but is otherwise healthy. We would not recommend it for a patient with health issues or comorbidities.
Q: What does a typical day of surgery look like?
A: A same day knee replacement patient will typically come in the morning, and we’ll first administer a nerve block. After they have received the block, they will go into the operating room and be put to sleep for the procedure. Once they are under anesthesia, the robotic arm will be calibrated according to the measurements of the patient’s leg. The knee will be balanced on the robot, which is used to make sure that there are precise cuts, better alignment and faster recovery.
Once the surgery is finished and the patient is awake, we will give them some post-operative pain medicine and get them on their feet, assisted by a walker or crutches. As long as they can do a good job of walking and meet other medical criteria, primarily vital signs, they are able to go home that afternoon.
Q: What if a patient doesn’t feel comfortable going home after the procedure? Do they have options?
A: We evaluate each patient thoroughly before they are released. If the patient isn’t medically ready to go home, they can certainly stay as long as they need to.
Q: Are there things a patient should do ahead of time to prepare for an outpatient knee replacement?
A: Prior to scheduling the surgery, we want to make sure that a patient is medically optimized. For example, if they are diabetic, they will need to keep their blood sugar in good control. If they are hypertensive, the hypertension would have to be in good control. Overweight patients will have to lose weight.
Patients may need to make some changes around the home. They should declutter to provide open spaces to move after surgery and install equipment such as ramps, handrails and bath mats to help avoid falls. It’s a good idea to set up areas in the home where the patient can sit and sleep comfortably with things they may need, such as glasses, phones, medications, water and snacks close at hand.
Before the procedure we will also order durable medical equipment the patient will need to ensure everything is ready for them when they get home.
Immediately prior to the surgery, the patient shouldn’t eat or drink after midnight.
Q: What can a patient expect immediately following surgery?
A: As with any surgery, some bruising and soreness are normal. It’s also common for knee replacement patients to feel new sensations, such as numbness, warmth or “pins and needles” in the area of the operation. Most of these will subside over time.
You may also hear popping or clicking noises when moving the new joint. Though they may sound alarming, these are usually not a sign of a problem.
All patients will have support and guidance as they recover. Home health will come to visit after a day or so. They will work with the patient on physical therapy, check their vitals and check the incision site. An occupational therapist will also visit to help with daily living.
"All patients will have support and guidance as they recover. Home health will come to visit after a day or so. They will work with the patient on physical therapy, check their vitals and check the incision site. An occupational therapist will also visit to help with daily living."
- Joseph L. Finstein, MD
Q: What is the timeline for full recovery?
A: Recovery from a same day knee replacement depends on what the patient is recovering from and whether or not the patient adheres to their rehab plan. The physical therapist will set an exercise schedule to help rebuild strength and regain range of motion. These exercises will change as the knee recovers and can range from simple knee bends in the beginning to step-ups to riding a stationary bicycle.
Pain should be significantly reduced at around week 3 after surgery, and at around 4-6 weeks, the patient should notice a marked improvement in their mobility and the ability to begin weaning off of any assistive walking device.
On average, recovery from a partial knee replacement takes about 6-8 weeks, while recovery from a total knee replacement may take 2-3 months.
It’s important to stay as active as possible and follow your physical therapy regimen for the fastest recovery.
Q: Are there signs patients should watch for once they get home that indicate they may need to contact their doctor?
A: If they have increased pain, increased swelling, calf pain, fever and chills. Those are the primary signs you should call a physician.
Q: What is the long-term prognosis for a patient who has had same-day knee replacement?
A: Once fully recovered, patients should experience much less pain in the joint than they did before surgery. Knee replacements last between 15 and 25 years, and patients usually have a very functional outcome. We advise them to avoid certain high-impact sports like basketball or football, but most patients go back to sports like swimming or golf. Those are good activities for patients with knee replacement to remain active.
Have Questions About Outpatient Knee Replacement?
Today’s post covers many of the common questions Dr. Finstein hears from his patients who have chronic knee pain which may require a same day knee replacement. However, every case is unique. If you have other questions or concerns or think you may be a good candidate, contact us today to schedule an appointment. We have two convenient locations available to see you.
About the Doctor
Joseph L. Finstein, MD specializes in sports medicine, focusing on shoulder, elbow, hip, knee, foot, and ankle injuries. Dr. Finstein completed his Sports Medicine Fellowship at the Rothman Institute at Thomas Jefferson University He is currently the team physician at De La Salle High School. Prior to joining Pontchartrain Orthopedics & Sports Medicine, Dr. Finstein assisted in the care of athletes from the Philadelphia Eagles, Flyers, Phillies, Soul and St. Joseph’s University.
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