Outpatient Knee Replacement

Total knee replacement is considered one of the most successful operations ever invented and is performed over 600,000 times annually in the US. It offers substantial pain relief and functional improvement for patients suffering from knee arthritis.

Recent advancements in the care for patients undergoing partial or total knee replacement have made it possible to shorten the length of stay post-surgery. And, for selected patients, safely offer knee replacement as an outpatient surgery. Outpatient knee replacement provides significant benefits for the patient. By avoiding the hospital stay, the patient minimizes the hospital-acquired infection risk, mobilizes quickly in the familiarity of their own home, and typically sees dramatic cost savings.

Outpatient Advantages

• Faster recovery
• Avoids risk of hospital-acquired complications
• Recovery in the safety and familiarity of your own home
• Substantial cost savings

Who is an outpatient candidate?

Outpatient knee replacement surgery is an option for healthy, motivated patients with a good social support network. Only after a thorough history, physical exam and review of imaging can you and Dr. DeClaire determine the most appropriate treatment plan for you.

How is outpatient knee replacement possible?

Outpatient knee replacement is possible through numerous technical improvements refined over the last 30+ years.

• Multi-modal pain management has dramatically improved postoperative pain control while minimizing medication side-effects.
• Minimally invasive techniques have allowed for early mobilization, improved strength and less pain.
• Advances in blood management have significantly reduced operative blood loss and nearly eliminated the risk of blood transfusion for healthy patients.
• An emphasis on patient education and active participation by the patient and their support network in the surgery preparation and recovery has improved outcomes.
• Adapting recovery resources to the home or outpatient setting has led to greater patient independence.
• Technological improvements in communication between the patient and Dr. DeClaire’s team at Michigan Knee Institute.

Risks

The risks of outpatient knee replacement are similar to the in-patient procedure. The possible complications after outpatient knee replacement can include:

• Knee stiffness
• Infection
• Blood clots (deep vein thrombosis)
• Nerve and blood vessel damage
• Ligament injuries
• Patella (kneecap) dislocation or avascular necrosis
• Plastic liner wears out
• Loosening of the implant
• Constipation
• Anemia
• Heart attack, stroke, death

The smaller incisions with minimally invasive surgery mean fewer tissue cuts resulting in quicker healing and recovery. The potential advantages of minimally invasive joint replacement surgery are:

• Minimal surgical dissection
• Shorter recovery period
• Shorter hospital stay
• Reduced post-operative pain

Minimally invasive surgery for knee replacement involves using smaller incisions that are only 4 to 6 inches in length compared to the 10-12inch long incision used in the traditional procedure.

• Surgery is performed under sterile conditions in the operating room under spinal or general anesthesia. 
• You will be lying on your back on the operating table with a tourniquet applied to your upper thigh to reduce blood loss. 
• Your surgeon will then make an incision along the affected knee to expose the knee joint. The surgeon first focuses on the femur (thighbone). 
• The damaged portions of the femur are cut at the appropriate angles using specialized tools. Then the femoral component is attached to the end of the femur with or without bone cement. 
• The next step involves removing the damaged area of the tibia (shinbone) and the cartilage, which allows for a smooth surface to attach implants. The tibial component is then secured to the end of the bone using bone cement or screws. 
• Dr. DeClaire will place a plastic piece called an articular surface between these implants to ensure a smooth gliding movement. This plastic insert acts similarly to the original articular cartilage. It helps in supporting your body weight and allows the femur bone to move over the tibia. 
• The femur and the tibia bone, with their new components, form the new knee joint and ensure that the patella (knee cap) glides smoothly over the new artificial knee. Its rear surface is prepared to receive a plastic component. With all its new components in place, the knee joint is examined through its range of motion. The entire joint will be irrigated or cleaned out with a sterile saline solution, and excess cement removed. 
• The incision is then closed and drains inserted—a surgical dressing or bandage placed over the incision.
• With less tissue damage around the knee during the minimally invasive surgery, you can expect a shorter hospital stay, faster recovery, and avoid an unsightly smaller surgical scar.