Outpatient Partial Knee Replacement

Recently there has been a plethora of procedural and technological advances making outpatient unicondylar knee arthroplasty (UKA), or knee replacement, procedures a viable, widely-accepted alternative for patients considering traditional inpatient knee replacement procedures in Florida. So, is an outpatient partial knee replacement procedure a better option than its inpatient counterpart?

With the new procedure, patients are on their way home from the surgery center in less than five hours the same day and report higher satisfaction scores when compared to the identical procedure done in a hospital setting.

If that’s not enough, they also report better pain management, quicker rehabilitation, expedited return to recreational activity, and the elimination of the risks of hospital-acquired infections. But how is the process completed?

Traditionally considered only inpatient procedures, new advances in the UKA allow for patients to experience recovery at home, almost immediately following the procedure. The choice for many leading joint specialists is the UniPath Outpatient Unicondylar Knee Arthroplasty Program, which utilizes the Zimmer partial knee replacement implant.

“We feel it offers a unique advantage over other systems,” says Jeffrey P. Rosen, M.D., a board-certified orthopaedic surgeon specializing in joint replacement at Orlando Orthopaedic Center. “This is a ‘high-flex’ implant, which offers a superior range of motion when compared to other systems and has excellent long-term results across the U.S.”

What Are the Advantages of Outpatient Knee Replacement Surgery for Patients?

The advantages for outpatient UKA for both the surgeon and the patient are numerous.

For patients, the higher standard for pre and post-op care has created an environment wherein patients can go home the same day from surgery and rest easy knowing they have adequate home health care and therapy teams to help them through the recovery process. By having the surgery performed at a surgery center they also interact with a smaller team, giving them more one-on-one attention while avoiding the headaches of parking and navigating their way through a large hospital system.

“Patient satisfaction has been outstanding, much superior to the same procedure performed in the inpatient setting,” says Dr. Rosen. “A lot of this has to do with making sure the patient knows that our staff and the home health care staff will be with them every step of the way.”

Of course, there are inherent advantages to any partial knee replacement, outpatient-based or otherwise. By keeping roughly 2/3 of the knee, patients describe the partial replacement as feeling “much more natural” when compared with a total knee replacement.

“In the partial knee replacement, we maintain all natural ligaments, most of the knee cartilage, and the surgery only affects a small part of the joint,” says Dr. Rosen. “Most patients feel the knee is ‘back to normal’ after an appropriate period of healing and rehabilitation.”

Speaking of recovery, most patients are fully healed and through with rehabilitation within six weeks. Most get back to driving using the surgical leg after a week’s time and are back playing golf at about six weeks following surgery.

What Are the Advantages of Outpatient Knee Replacement Surgery for Surgeons?


Dr. Rosen Outpatient Partial Knee Replacement

For surgeons, increased emphasis on the development of consistent protocols for pre-operative and post-operative care have helped lead to a higher standard of care for patients, allowing them to go home the same day as surgery.

Coupled with technological advances, these protocols have also created an environment where surgeons can perform the partial knee replacement surgery in an outpatient surgery center rather than a hospital. Orlando Orthopaedic Center utilizes their very own outpatient surgery center, located across the street from the main downtown office, for this and many other procedures. This facility provides the surgeons with the benefit of having dedicated anesthesia and surgical staff to assist with each and every patient, again helping to ensure consistent quality care.

When developing their program, Accelero, the proprietors of the UniPath system, placed an emphasis on patient focus groups. One of their largest concerns expressed was adequate home pain management, post-op nausea, and making sure that home health staff was consistent and reliable. “We have successfully addressed all of these issues, and continue to closely monitor patient satisfaction,” says Dr. Rosen.  “We find that patients are much more comfortable in a home setting, and rehab much more quickly.”

Of course, to see the best results, specifically, when referring to an outpatient, partial knee replacement, surgeons must ensure they are choosing the right candidates for the procedure.

Who Is the Right Patient for an Outpatient Knee Replacement Surgery?

To ensure excellent results, it is important to evaluate patients adequately to make sure they will benefit, and are appropriate candidates, for an outpatient procedure. But first, a patient must meet all the criteria for a partial knee replacement before even being considered for the outpatient procedure. According to Dr. Rosen, the most important issue to determine if a patient is indeed a candidate for a UKA is to confirm they have arthritis localized to only one of the three “compartments” of the knee.

“For a patient with more extensive arthritis, the partial replacement will not achieve the intended result of painless, normal range of motion and function of the knee. These folks are more appropriately treated by considering total knee replacement,” he says. “We evaluate the patients in some ways to make this determination, including standing X-rays, stress X-rays, MRI scans, physical exam and sometimes arthroscopic evaluation.”

Interestingly, Dr. Rosen says that as he evaluates patients who express interest in the UniPath outpatient program, he is finding that many who have been told by other surgeons that they “don’t need surgery” are actually excellent candidates for the partial knee replacement because they’re still experiencing pain and medical management have been rendered ineffective.

To be considered for the outpatient UniPath procedure, patients must fit a certain medical “risk profile” and should not have medical issues that pose an unreasonable risk.

“We ask the patient’s medical physician to assist us by performing a preoperative medical evaluation. Patients who are deemed ‘high risk’ can still have the partial knee replacement surgery, but more safely as an overnight hospital stay, with a planned discharge home the next day,” says Dr. Rosen. “About 2/3 of the patients that ultimately have the procedure are appropriate for the outpatient setting.”

How Is Outpatient Partial Knee Replacement Performed?

Once the patient has elected to go forward with the UniPath outpatient partial knee replacement procedure, there are several additional steps that must be taken when compared to an inpatient partial knee replacement procedure. First, there is a pre-op teaching protocol which involves one additional office visit with the surgeons to go over all details of the procedure; then there is a pre-op visit with the anesthesiologist, and finally there are home visits by the home health and physical therapy (PT) providers. Home equipment, such as a walker, elevated toilet seat, cold therapy unit, etc. are all delivered before surgery. A comprehensive, detailed home instruction booklet will be provided to the patient as well. This booklet is “all-inclusive” and covers all aspects a patient needs to know for pre-op, their day at the surgery center and post-op home care.

“On the day of surgery, the patient will arrive about two hours ahead of time, and will receive IV antibiotics, a nerve block for post-operative pain control and preoperative medications to control nausea,” says Dr. Rosen. “The surgery will take about an hour and a half and the patient will then remain at the surgery center to be monitored for another 2-3 hours.”

What Is Recovery Like After an Outpatient Partial Knee Replacement?

Once ready, the patient will be discharged home. To relieve pain, a protocol referred to as “multi-modal pain management” has been developed and has proven to be highly successful in providing adequate pain relief, both at the surgery center and at home for the first several days.

At home, the patient will be seen on the day of surgery once, possibly twice, by a home health nurse and a home physical therapist. Medications are provided for pain and nausea as necessary, and home health and PT will then continue daily for 14 days.

“A follow-up visit with the surgeon is scheduled at about two weeks post-op,” says Dr. Rosen. “If necessary, we then transition to outpatient therapy or independent exercise at a health club, whichever is most appropriate for the individual patient.”

What Are Results of Outpatient Knee Replacement Surgery?


Benefits of Outpatient Partial Knee Replacement

Dr. Rosen says, without a doubt, the two keys to long-term success of the procedure are:

  • Identifying the appropriate patient (one who will benefit from a partial rather than a full knee replacement, and one who meets the medical risk profile for safe outpatient surgery)
  • Ensuring the patient receives quality, consistent care throughout the program

“Done in the proper patient, the UniPath outpatient partial knee replacement has proven to yield excellent results,” he says. “Patient satisfaction scores, knee function scores and return to normal activity level have all proven superior to the same procedure done in a hospital setting. Outpatient, Partial knee replacement is a great alternative for patients who want to get back to enjoying their day-to-day lives.”