Facts About Outpatient Knee Replacement

It is possible for a patient to be safely discharged home the same day after partial or total knee replacement surgery, without ever being admitted to a hospital. Outpatient knee replacement currently accounts for only a small percentage of all knee replacement surgeries in the US, but experts believe it will become more common over the next decade. ¹ Dyrda, L.16 things to know about outpatient total joint replacements and ASCs. Becker’s ASC Review .https://www.beckersasc.com/asc-turnarounds-ideas-to-improve-performance/16-things-to-know-about-outpatient-total-joint-replacements-and-ascs.html. Published February 10, 2017. Accessed October 22, 2018. ^{, 2} Advisory Board. Hospitals may lose total joint replacements to ambulatory providers. Here's what they're doing about it. https://www.advisory.com/daily-briefing/2017/08/10/joint-replacement. Published August 10, 2017. Accessed October 22, 2018.

The Trend Toward Shorter Hospital Stays

Decades ago, hospital stays following knee replacement surgery were about 10 days. Now, typical hospital stays range between 0 and 3 days. This trend is the result of several changes, including:

• Advancements in knee replacement surgery—for example, current surgical procedures call for the use of tranexamic acid, a medication that helps minimize blood loss ³ Shang J, Wang H, Zheng B, Rui M, Wang Y. Combined intravenous and topical tranexamic acid versus intravenous use alone in primary total knee and hip arthroplasty: A meta-analysis of randomized controlled trials. Int J Surg 2016;36:324-329. As cited in Lazic S, Boughton O, Kellett CF, Kader DF, Villet L, Rivière C. Day-case surgery for total hip and knee replacement: How safe and effective is it? EFORT Open Reviews. 2018;3(4):130-135. doi:10.1302/2058-5241.3.170031.

  See Total Knee Replacement Surgical Procedure

• A better understanding of the medical risks associated with surgery and the development of ways to minimize those risks and associated complications

  See Total Knee Replacement Risks and Complications

• Improvements in identifying who will recover well after surgery versus who might be at high risk for specific postsurgical problems and who should avoid surgery altogether

  See Total Knee Replacement Surgery Recovery

• Better and more predictable anesthesia and pain control methods that can improve comfort, minimize side effects (such as nausea), and speed recovery

  See Anesthesia for Orthopedic Surgery

• Many more younger, healthier patients undergoing knee replacement surgery

Improved patient education via print materials, video, and even smartphone apps that help prepare patients and their caregivers for recovery, has also facilitated the trend toward outpatient surgeries.

See What to Expect After Knee Replacement

Is Outpatient Knee Replacement Safe?

Most current research suggests that outpatient knee replacement, for the properly selected and prepared patient, is as safe as inpatient surgery. ⁴ Pollock M, Somerville L, Firth A, Lanting B. Outpatient Total Hip Arthroplasty, Total Knee Arthroplasty, and Unicompartmental Knee Arthroplasty: A Systematic Review of the Literature. JBJS Rev. 2016;4(12). ^{, 5} Lazic S, Boughton O, Kellett CF, Kader DF, Villet L, Rivière C. Day-case surgery for total hip and knee replacement: How safe and effective is it?. EFORT Open Rev. 2018;3(4):130-135. For these select patients, while there may be a trade-off in potential risks, there is no evidence of an overall statistical increase in risks. ⁶ Basques BA, Tetreault MW, Della valle CJ. Same-Day Discharge Compared with Inpatient Hospitalization Following Hip and Knee Arthroplasty. J Bone Joint Surg Am. 2017;99(23):1969-1977.

Does outpatient knee surgery take place in a hospital?
Outpatient knee replacement can take place at a hospital or an ambulatory surgery center.

An ambulatory surgery center is a health care facility specifically designed for outpatient surgeries. Many—but not all—of these centers are certified by Medicare and/or hold other professional accreditations.

Plans for early discharge can change
Rarely, plans for a same-day discharge must be cancelled and the patient is observed overnight in the ambulatory surgery center or is admitted to the hospital.

Reasons for observation or admission may include difficulty controlling pain, urinary retention, nausea and/or vomiting, significant blood loss during surgery or low blood pressure. These signs do not necessarily indicate medical complications; however, they are signs that the patient needs extra time to recover before being sent home.