Knee replacement surgery in the morning, and back home that evening? Many patients are surprised to learn it is an option. Forgoing a night in the hospital has become increasingly common, and improvements in knee replacement technology, surgical technique, and pain management – including prehabilitation – make it possible, says Martin W. Roche, MD, an orthopedic surgeon and director of joint replacement at HSS Florida in West Palm Beach.
Many patients are pleased to spend the first night after surgery in the comfort of their own home, he says. “We’ve come a long way in terms of being able to get people up and out of the hospital quickly, and that motivates them mentally, as well,” he explains.
Further Reading: Post-Op Knee Rehab Refresh
Dr Roche points to advances over the past five years or so that benefit patients and can lead to a faster recovery: a CT scan before surgery to create a 3D model of the patient’s knee to plan a highly personalized procedure; the use of surgical robotics and sensors that allow for a high degree of precision and accuracy; less invasive, muscle-sparing surgery performed with smaller incisions; and a program called “pre-habilitation,” in which patients begin physical therapy to get stronger prior to knee replacement.
A longer-lasting regional nerve block and a technique known as multimodal analgesia result in better pain control after surgery − another advantage for patients wishing to leave the hospital the same day, according to Roche. The technique uses various medications that target multiple pain pathways, as needed, and generally lessens the need for opioid medications.
The best candidates for outpatient knee replacement are highly motivated individuals in good general health who have the right home environment, including support from family, a friend, or a caregiver.
Seventy-three-year-old Robert Fleetwood fit the bill. He was motivated to have joint replacement in both knees not only to relieve arthritis pain, but to get back to the athletic activities that were once his passion. He said he was happy to learn he was a candidate for ambulatory surgery. He had two knee replacements several months apart last year and each time went home the same day.
Dr Fleetwood, who lives in Stuart, says it changed his life. This year, he participated in a 1K Navy SEAL memorial open water swim, competing with many people half his age. He came in second out of participants ages 60 and up, and 30th out of about 150 swimmers. He is also back to running for exercise for the first time in more than 20 years.
Fleetwood, who has a PhD in clinical and industrial organization psychology, travels to Atlanta about 12 times a year for work. Before the knee replacements, he dreaded all the walking at the airport. He is thrilled that he can now travel pain-free.
“It changes your perspective on life. It makes you feel so much more alive and dynamic when you’re not living with chronic pain that becomes debilitating,” he explains. “I’m very happy now.”
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