Joint surgery isn’t just doing a good procedure. It takes a team of people to do a joint surgery, and it’s about having the right team. I think having the right team is a strength of ours at the outpatient surgery center where I do my surgeries.
When I first started doing joint replacement surgeries, we would admit a patient on a Wednesday and schedule them for appointments with physical therapy, a dentist, cardiology, and any other appointments they needed to get ready for surgery. After having the weekend off, the plan was that they would be able to have surgery the following Wednesday. Then they would stay in the hospital about a week.
Fortunately for patients, things have changed. Length of stay in a hospital after a joint replacement is about a day or less, and many patients qualify to do outpatient surgery for joint replacements where they go home the same day.
Advances in medical technology allow the outpatient procedures. We control pain better, we get patients moving around and out of the hospital, and we have fewer transfusions. Patients are able to go home, which is important because patients who go to rehab facilities are two and a half times more likely to return to the hospital because they are less mobile.
Patients also like outpatient procedures because they cost less and they are able to start recuperating at home instead of at a hospital.
Outpatient procedure screening
Patients who want to do the outpatient procedure need to be screened to make sure that they are appropriate candidates.
- Are you motivated?
- Are you going to be getting up and moving early?
- Are you healthy enough to have it done outpatient?
- Do you need extra medical care for a different condition?
- Do you have someone available to be at home with you after surgery?
Frequently Asked Questions
How long is recovery after outpatient total joint replacement?
Most patients have pain before surgery and after surgery, and the crossover where the patient is feeling better and feels like they are recovering can be fairly early in the recover process. You’ll go home using crutches or a walker for the first two weeks, and then when you come in for your post-op visit hopefully you will be walking by yourself and can start driving. You also start outpatient physical therapy quickly after surgery.
Returning to work varies, but patients usually take six to eight weeks off work. If someone is able to work from home using a computer and mostly sitting down, they may being working as soon as they are off narcotic pain medicine. People who have jobs with a lot of lifting and climbing, such as heavy construction workers, may need extra time. Farmers who have to take care of their animals may be more motivated and may go back sooner than others.
What kind of anesthesia is used?
During surgery, we use general anesthesia with some regional blocks to help with the pain. We don’t use spinal anesthesia because it requires extra time to wear off, and we want to get you out of bed and moving quickly. As soon as you get in the recovery room, you’re moving and walking around.
We use a multimodal pain modality that includes steroids, anti-inflammatory medications, and maybe a small amount of narcotics. A multimodal approach like this, which addresses your pain in different places, helps reduce narcotic use. Over time we transition you off the pain medications.
Are all joint replacements outpatient?
No, not all patients are good candidates for outpatient procedures. For an outpatient joint replacement, a patient needs to meet the criteria described above.
How long does the joint replacement itself last?
Historically, joint replacements have lasted about 15 to 20 years, assuming early risks are avoided. What we use today will probably last longer, but we can’t say for certain until that amount of time has passed.
How long is the surgery itself? Is it the same amount of time as an inpatient procedure?
It usually takes less than an hour, regardless of it is outpatient or inpatient.
What is prehab and does it help?
Prehab is physical therapy before surgery, helping make a patient as mobile and as strong as possible before the surgery. Strength and mobility before surgery influence strength and mobility after surgery.
Can someone who had a major heart attack have outpatient joint replacement and if so, what precautions are taken?
For patients with heart disease, the patient’s cardiologist and the anesthesiologist will decide if a joint replacement surgery is safe and possible.
How soon can you go up stairs after a knee replacement?
One requirement of going home after your knee replacement surgery is being able to do stairs. If you’re having surgery in the hospital, you’ll get up and down stairs the next day. If you’re having surgery as an outpatient, you’ll make sure you can go up and down stairs before you leave.
How do you decide when it is time to do surgery?
Surgery is done when you have failed all conservative treatment: therapy, anti-inflammatory medications, Tylenol, and injections. Once those treatments do not work and it’s interfering with your quality of life, then it’s time to have surgery. If you use a cane before surgery, you’re likely to use it after surgery. Those patients that have better range of motion before have better range of motion after. The better health you have, the better you’re going to do. So we want to make you optimized for success as much as possible. If your pain and discomfort is stopping you from walking or stopping you from doing things that you would normally do, then it’s time to do surgery.