A Patient’s Guide to Outpatient Total Joint Replacement

by George Aguiar, M.D. and Vignesh Alamanda, M.D.

A Patient’s Guide to Outpatient Total Joint Replacement

Here at OrthoVirginia, we have been performing outpatient surgeries for several years. Over the last few years, we started a very effective and proven outpatient total joint center program. In the past year and a half, we’ve conducted well over 200 outpatient joint replacements, half of those using the Mako robot.  

What is a hip or knee joint replacement? 

A joint replacement procedure for the hip or knee is performed when patients have end-stage arthritis of the joint, where the cartilage in the hip or knee joint is completely gone.  

A joint is two bones coming together. Cartilage acts as a protective barrier covering the joint and allows your body to move smoothly without pain. When that protective barrier wears away in the hip or knee, a joint replacement is needed. 

During a hip or knee replacement, the diseased part of the cartilage is removed, and an artificial implant is put in. This implant recreates that smooth, pain-free range of motion for your hip or knee.  

Joint replacement procedures, also known as arthroplasty, have been around for decades. But the process has changed significantly since its inception thanks to medical advancements. In the first stages of joint replacement in the 1960s and 1970s, patients were often admitted to the hospital. They would spend 14 days there post-operation for rehab. It was a long process.  

Today, we are performing joint replacement surgeries in a minimally invasive fashion, and we’re using advanced technologies like robotics. These new techniques help speed up recovery and help get you back to your life faster.  

Outpatient joint replacements have been on the rise. In the early 2000s, outpatient joint replacements were only a tiny percentage of the total joint replacement surgeries taking place. Now, more and more patients are understandably choosing outpatient total joints. Who wants to stay in the hospital if they don’t have to?  

What are some common causes of hip and knee pain? 

In the older population, hip and knee pain is usually from arthritis. Arthritis can develop for numerous reasons. 

The first is genetics. If your mom, dad, or grandparents had arthritis, the higher your chances are of also having arthritis. Additionally, as you go through life, you are putting more stress on the hip or knee, causing the cartilage to wear down.  

If you were involved in an injury or an accident that led to damage of your cartilage, then your risk of developing arthritis at an earlier stage in life increases due to post-traumatic arthritis.  

You can in a sense be born with arthritis. If you have dysplasia, for example, in which the socket of the hip is not fully formed, then you could develop arthritis from a deficient or shallow socket. If you have medical problems like rheumatoid disease or if you’re on prednisone, you could get what is called avascular necrosis (the death of bone tissue due to a lack of blood supply) which can lead to arthritis. 

Unfortunately, once cartilage is gone, it’s gone. 

When is it time to see a specialist? 

If you have pain, swelling, dysfunction, disabilities, or feel like you’re not able to do daily activities in your life, you should make an appointment with a specialist. 

What are the treatment options?

Treatment for arthritis is very broad depending on the stage of your arthritis. If you’re in the early stages, then we try non-operative options such as physical therapy to help strengthen the muscles around the joint. We can use cortisone injections and gel injections to help restore some function and delay surgery. There are also options such as anti-inflammatory medications and exercise programs. 

When your arthritis is severe, and the more conservative treatment options are not helping, then surgical treatment such as a joint replacement comes into play. 

What are joint replacement surgical options?

For hips, the joint replacement option is a total hip replacement. For the knee, the options are partial or total knee replacement, depending on the severity and location of the pain. 

In the knee, for example, if the pain is solely on the inner side (medial), the outside (lateral) or the knee cap, then a partial knee replacement is considered. If the pain encompasses the entire knee, then a total replacement might be the best plan. 

The Mako robot is capable of performing all three procedures with incredible accuracy. 

What are the preparations for surgery? 

One of the most important aspects of surgery is not the actual surgery itself but what happens before and after the procedure. Things such as strengthening the muscles around a joint can help take away pressure from that joint before surgery, and it can also pay dividends down the road after surgery during rehab. It will make recovery a lot easier. 

Other things include getting your diabetic glucose under control if you’re diabetic and reducing your weight if you’re overweight. We call all of these before surgical measures pre-operative optimization. These practices in medical studies have been proven to make a big difference in the outcome of surgeries. 

Patient testimonial 

The following Q&A was conducted with Greg, an OrthoVirginia patient who received a knee replacement two months prior to the interview. He provides an insight into his own personal experience with an outpatient joint replacement procedure. 

Before your knee replacement, how many surgeries did you have on your knee? 

I had three ACL replacements prior to a knee replacement due to sporting injuries that lead to severe arthritis and deformity of my knee. 

Why did you decide to have surgery? 

My quality of life was decreasing.  

The number of activities I could do was greatly reduced. I couldn’t walk more than maybe a mile before I had to stop because of the pain and/or swelling. I wanted to get back to doing my outdoor activities comfortably. 

What made you choose to undergo outpatient robotic knee surgery? 

This style of procedure meant I didn’t have to spend an extended period of time in the hospital. The robotics portion of the procedure felt like a good option due to the deformity in my knee. I knew the robot would be able to realign my bones with great accuracy.  

What was your physical therapy experience like? 

On day one of therapy, the therapists told me I already had a solid amount of flexibility. They really just helped me further increase my flexibility and strength levels.   

What was your pain level after surgery? 

It was what you would expect it to be: a constant nagging, inner pain. But it was by no means extreme. 

I had a hard time sleeping, but it didn’t interfere with my mobility that much. I actually found walking around helped reduce some of the pain. 

How long until you could go up and down stairs or get around the house more efficiently? 

I was able to move around my house pretty quickly, within the first couple days. 

I only had to use a crutch for a week to navigate up and down the stairs. 

When did you start driving? 

Two weeks after surgery.  

How is the flexibility in your knee now? 

I have almost full mobility. I am able to straighten my knee completely, but I can’t bend it quite as much as I would like to. 

Are you able to do the activities you weren’t able to do prior to surgery? 

I can walk without any pain. I haven’t gotten back to outdoor hiking yet, but I don’t anticipate I will have any problems once I go on that first hike. 

Frequently asked questions 

I have arthritis in my knee. Some days it’s tolerable. Some days it’s not. How do I know when it’s time for a knee replacement? 

With arthritis, you can have good days and you can have bad days. Usually, we tell our patients when you start planning your days around your knee or your hip (you can’t go on a hike, you can’t garden, etc.), then that’s a sign you need to make an appointment with a specialist.  

What are the main benefits of having a total knee replacement using the Mako robot? 

The robot makes us better surgeons. It gives us the ability to be so much more precise.  

Prior to the robot, the traditional method was to “eyeball it.” Thanks to advancements such as the Mako, we have more information at our disposal, and therefore get a better sense about the patient’s alignment in real time during the surgery.  

We can also tailor and customize the surgery to a patient’s unique situation and anatomy even more.  

Is there proof that the recovery time is faster after a Mako knee replacement? 

The Mako takes the guesswork out of the surgical equation. Components such as artificial knees and hips are put in more precisely. Bone alignment is much more accurate. Cuts into the bone are dialed in to the exact spot they need to be made.  What all of those factors lead to is a patient’s ability to transition into a physical therapy regimen much more smoothly and to progress in that program at a much faster pace. 

What is the difference between the anterior and posterior approach for a hip replacement? 

There are a variety of ways to access the hip joint. Accessing the hip from the front is the anterior approach and from the back is the posterior approach. Each approach is a little different. Deciding which angle to take depends on the patient’s age and bone quality.  

Both approaches have their pros and cons. We always tell patients don’t choose the approach. Choose the surgeon. The surgeon will decide what is best for your individual condition.  

Are major procedures such as hip or knee replacements really just as safe at an outpatient facility vs. an inpatient facility? 

Whether it’s out or inpatient, you want a facility with a proven track record of effectiveness regarding their total joint program. You want to know that they have had many patients go through the program and received great results.  

Over the past year and a half, we’ve done well over 200 outpatient joints in our facility. When it comes to our specific program, yes, we recommend visiting our outpatient facility.  

Issues arise from the patient’s health. At our facility, we have screening criteria. Our nurses and our anesthesia team will look at the patient’s chart and make sure that it is safe for that particular patient to undergo outpatient surgery at our site.