A doctor will only suggest outpatient knee replacement surgery if he or she believes the patient will recover at home as well or better than in the hospital. Patients who are approved to recover at home the same day as surgery must have a low risk of experiencing post-surgical complications.
Surgeons and their teams use screening measures to select the best candidates for outpatient replacement. For example, surgeons will ask themselves several questions before recommending outpatient knee replacement, including:
- Does the patient want same-day knee replacement surgery?
- Is this particular knee replacement surgery appropriate for outpatient treatment?
- Is the patient in good health?
- What is the person’s home living situation?
The answers to these questions are important to the overall safety and success of post-surgical recovery.
1. Does the Patient Want Same-Day Knee Replacement Surgery?
Patients who undergo same-day knee replacement surgery agree take on some extra responsibilities, so they must be motivated. Some patients would prefer not to take on these responsibilities and instead rely on their hospital health care team—and that’s okay.
2. Is the Knee Replacement Surgery Appropriate for Outpatient Treatment?
Straightforward partial or total knee replacements may be considered for outpatient surgery.
More complicated surgeries may require at least one overnight stay in a hospital for post-surgical care and monitoring. Examples of complicated surgeries include double knee replacements, in which both knees are replaced, and knee replacement revisions, in which an existing knee joint prothesis is replaced.
3. Is the Person in Good Health?
A candidate for outpatient knee replacement must be in overall good health. When evaluating overall health, the surgeon will consider existing medical conditions and other health factors, such as age and weight.
Existing medical conditions
Patients who have only mild disease or well-controlled conditions are typically eligible for same-day knee replacement surgery.
Patients who have more serious, uncontrolled, or multiple medical conditions may require monitoring in a hospital setting for 1 night or more. For example, chronic obstructive pulmonary disease, congestive heart failure, uncontrolled diabetes, morbid obesity, kidney failure, and cirrhosis of the liver are associated with increased risk of post-surgical complications.
Other health factors
Below are other health factors that a surgeon will consider:
- Weight. The ideal candidate for outpatient knee replacement surgery will have a normal BMI. People who are obese are at a greater risk for postsurgical infections and other complications.
- Age. Advanced age is considered a risk factor. Younger patients have a lower risk of post-surgical complications. However, as with other risk factors, healthy older patients with good social support can still achieve good outcomes with outpatient surgery when properly prepared and selected.
- Nicotine use. Smoking and other habitual nicotine use can hamper the body’ ability to successfully heal, increasing the risk of infection.
- Depression or anxiety. People who have significant depression and/or anxiety may catastrophize pain. They may become hyper-focused on their postsurgical knee pain, worrying that it will get worse or never go away, which can create an unhealthy feedback loop that leads to an increased perception of pain.
- History of chronic pain. People who have a history of chronic pain, especially chronic pain treated with opioids (narcotics), may benefit from inpatient pain management in the first day or two after surgery, when knee pain can be most unpredictable.
- History of opioid use. People who have a history of opioid (narcotic) use—either medical or recreational use—are often hyper-sensitized to pain and may have difficulty achieving acceptable immediate post-surgical pain relief as an outpatient. It is strongly encouraged that all narcotics be stopped prior to surgery.
- Ability follow through with directions. Patients must be able to follow through with recovery instructions. People who have dementia or are heavy drinkers are not good candidates.
Patients are advised to be open and honest with their surgeon while providing a health care history.
4. What Is the Person’s Home Living Situation?
A surgeon will ask questions about the patient’s home living situation, including questions about:
- Live-in support. Just as with discharge from a hospital in-patient stay after joint replacement, family, friends, or hired support will be needed for household help, meals, and transportation for the first few days or weeks after surgery. Ask your surgeon about transportation assistance, as there are often simple solutions to assist with transportation to physical therapy or follow-up visits.
- Pets. Pets can get underfoot, and a cat toy or dog bed can be a tripping hazard. It is encouraged to board pets for the first few weeks after joint replacement to minimize fall risk.
- Stairs. Patients will be educated on how to safely navigate stairs after surgery. In some cases, a pre-operative home visit can be pre-arranged to help prepare for an individual’s unique situation. Patients are advised to let their surgeons know if they have unusual living situations.
- Sleeping situation. Ideally, the bed is easy to access. In addition to stairs, the bedroom layout and the height of the bed may be considered.
There may be certain situations in which a patient may recover more safely in a hospital. Patients are asked to alert their surgeon if they are concerned about their social support or home situation after surgery, whether the surgery is performed as an out-patient or in-patient. There are often resources available to assist patients in these situations.