Outpatient Total Joint Replacement: What You Need to Know

by William P. Petersen, M.D., MPH and Thomas J. Klein, M.D.

Outpatient Total Joint Replacement: What You Need to Know

Outpatient total joint replacement surgery is available for total hip replacements and total knee replacements. This blog explains what outpatient total joint replacement surgery is, who may be a candidate, and the steps of the process.

Background

More than half of the older adult population in the United States suffers from some sort of arthritis. Osteoarthritis is caused by the cartilage that cushions our joints wearing down, causing swelling, pain and disability. Since the 1960s, people with severe osteoarthritis have had the option of replacement with a prosthesis made of either metal, ceramic or plastic. The prosthetic design has been improved over the years and is designed to replicate the normal motion and movement of a healthy joint. According to the Agency for Healthcare Research and Quality, there are over 300,000 total hip replacements done in this country each year.

Outpatient total joint replacements are also known as same-day joint replacements. In the past five years, around 15% of joint replacements were done as a same-day outpatient procedure. However, the amount of outpatient procedures has grown dramatically. By 2026 we’re predicting that about 51% of our joint replacements will be outpatient.

Hip and Knee Pain

Pain in the hip may not be arthritis. Tendonitis is inflammation in the tendons that attach muscles to bones and is caused by using your hips too much. Tendonitis is usually resolved with medication and stretching. Bursitis is another type of inflammation that can occur in the hip and is usually a nagging pain in the side of the hip. A cortisone shot often helps relieve the pain. 

Hip arthritis pain is commonly felt in the groin. You’ll have pain when you rotate your hip and discomfort when you lift up your leg. Having trouble putting your shoes on is a common sign. Hip arthritis may also cause knee pain.

Knees can also have tendonitis and inflammation in the knee from jumping, moving in different directions, or overuse. Knee arthritis often presents with swelling in the knee, aching with walking and pain with activity. 

When to See a Doctor

Many joint problems can be initially managed by your primary care physician. Exercise, heat, ice and anti-inflammatories can manage the pain. When those conservative treatments are not working to manage the pain and discomfort, talk to your primary care doctor about a referral.

Care Options

Joint replacements don’t last forever, so it’s important to try to time the replacement so it only needs to be done once in your life. Most patients start with conservative treatments, like activity modification, physical therapy and steroid shots. Activity modification can make a significant difference. Physical therapy can help you strengthen the muscles around your joints to help you delay joint replacement, reduce pain, and make your surgery more successful.

Anti-inflammatory medications can help reduce pain and discomfort. Injections such as cortisone shot can be helpful to provide relief and delay surgery.

Try to maximize all conservative measures to put off surgery as long as you can, especially if you’re in your 40s or 50s where the time makes an important difference. 

Surgery

Outpatient joint replacements aren't new. Patients have been going home the same day for years, but it's become more popular over the past couple years. The Center for Medicare and Medicaid Services has rules about which procedures can be done only in a hospital and which procedures are safe to do as an outpatient. Recently total hip replacements and total knee replacements are beginning to be removed from the inpatient-only list, which has made orthopedic surgeons start to prepare patients for the future of more outpatient surgery. During the pandemic we started to turn to outpatient joint replacements even more.

When deciding if you’re a good candidate for outpatient surgery, you must get evaluated by a primary care doctor to make sure that it is safe. Your primary care physician will make sure that your heart and lungs are functioning well and will do blood tests. Another important part of outpatient surgery is the support system. Patients who choose outpatient surgery need to have people around them who they are comfortable with to help them after the surgery.

We work with patients in several different ways to prepare them for surgery, including what to expect before surgery, the day of surgery, and after surgery. Patients may talk with nurses, look at online content and printed content, and attend joint replacement classes. 

We approach pain differently these days. We treat pain with a multi-modal approach which includes patients taking pills that will release pain medication periodically. Our anesthesiologists use a spinal epidural to numb you from the waist down. Often, they do guided blocks for certain nerves around the joint being operated on to help keep the pain at bay for the first 24 to 48 hours after surgery. We have physical therapists come see you post-surgery to discuss long-term recovery plans.

Outpatient surgery has become increasingly popular because it decreases the chances of infection. Infections are more likely at hospitals, and patients leave hospitals and operatories quickly after outpatient surgery. Because patients are out of bed and walking sooner, outpatient surgery also reduces the risks of blood clots.

Recovery

While hip and knee surgery recoveries are different, the general timeline is similar. Patients usually get over the initial trauma from the surgery around six weeks after surgery. Between six weeks and three months, symptoms and inflammation start to wind down and strength and mobility increase. For most patients, recovery starts to accelerate around three months after surgery. The entire recovery process usually takes a year. If the joint is taken care of, it can last for 20 to 25 years.