“It’s been wonderful for my patients. Most importantly, it allows them to go home the same day of surgery, where they can start their therapy at home. We provide a therapist sometimes in the home, as well as nursing. It’s a jumpstart to ultimate recovery.”
“The nice thing about going home right after surgery is that you have a 0% chance of a hospital-acquired infection because you never entered the hospital,” Dr. Reuss continues. “There’s never been an advantage of being in the hospital over being outpatient with regards to outcome, as long as the patient is a candidate.”
When Should You Consider Total Knee Replacement Surgery?
Total knee replacement is typically used as a last resort for patients where pain and loss of function become intolerable and who have not had success alleviating their symptoms with more conservative treatments such as lifestyle changes, pain medication, steroid injections, and physical therapy.
A surgeon may recommend total knee replacement for patients who experience:
- Significant knee pain or stiffness that hinders routine activities such as sitting, lying down, and walking
- Chronic swelling in the knee that does not improve with rest or medication
- Persistent pain and rigidity despite attempts with non-surgical treatments
“My knee had deteriorated to the point where it was tough for me to walk,” says James. “I could manage maybe 100 yards before I was limping badly and dragging the leg. I was in a contract job with the elections supervisor in Orange County, and it was very difficult for me to get around on the job. It was also painful for me to do a lot of my favorite things such as a morning walk, which I like to do with my wife.”
With retirement around the corner and a move to hilly North Carolina on the horizon, James knew he couldn’t go on living with his knee as it was. “My wife is finally retiring, so we’re moving to Murphy, North Carolina, where to get anywhere you need to walk up or downhill, and I really couldn’t tolerate my knee the way it was,” he says.
After consulting with Dr. Reuss, James decided that outpatient total knee replacement would give him the best chance to reclaim his quality of life.
“I went for total knee replacement, which was the second one in my adult life,” James says. “I had my left knee done about seven or eight years ago (at another medical practice), and that was a completely different procedure; I was in the hospital for several days, and it took me quite a while to become ambulatory at all. I required home therapy and regular visits from the nurse for at least a couple of weeks.”
The Benefits of Outpatient Total Knee Replacement
Outpatient knee replacement surgery can provide equivalent or better outcomes as inpatient (hospital) knee replacement while also reducing costs, increasing patient comfort, and avoiding the risks associated with hospital admission.
The advantages of outpatient vs. in-hospital total knee replacement include:
- More advanced care. Ambulatory outpatient centers tend to be newer, more technologically advanced, and run by innovative surgeons who practice the most leading-edge orthopaedic techniques.
- Lower rates of infection. The shorter the stay in a care facility, the lower the risk of infection.
- Recover at-home. Many patients prefer to recover in their own space where they are comfortable. They may sleep better in their own beds and be happier eating familiar foods.
- A greater focus on pre-op preparation. Outpatient surgery centers tend to invest more in preparing patients mentally, physically, and environmentally for the procedure thereby contributing to lower risk, improved outcomes and speed of recovery.
- Decrease medical costs. Research studies have concluded that the average cost associated with outpatient knee replacement is roughly $8,500 less than those for a knee replacement followed by a 3- to 4-day hospital stay.
Despite his less than optimal experience with his previous knee replacement, James was thrilled with how his outpatient total knee replacement with Dr. Reuss unfolded. “This procedure was entirely different,” says James. “It was outpatient surgery, which I found incredible when it was described to me. I was reluctant to undergo the procedure because of my previous experience, but this time I have nothing but positive things to say.”
What is a Total Knee Replacement?
First introduced in the U.S. in 1968, total knee replacement surgery (also known as total knee arthroplasty) is one of the most widely performed and successful surgeries in the country. Over 600,000 procedures are performed every year.
During total knee replacement surgery, a surgeon removes damaged bone tissue and cartilage from the knee and replaces it with an artificial joint composed of metal alloy and state-of-the-art plastic.
Total knee replacement can typically be broken down into four stages:
- Preparation of the thigh and shin bones by removing any damaged cartilage and bone
- Cementing and positioning metal implants to recreate the joint’s surface
- Resurfacing the knee cap by inserting a plastic button behind the patella
- Insertion of a cutting-edge plastic spacer between the metal components to form a fluid gliding surface, allowing the knee to move freely
Who Is a Candidate for Outpatient Total Knee Replacement?
According to Dr. Reuss, for a patient to be a candidate for an outpatient knee replacement, they need to have a caregiver at home to assist with recovery for at least five days after surgery. “A patient has to be healthy enough to be able to undergo the procedure,” he says. “So things like heart disease, uncontrolled diabetes, or the inability to ambulate without assistive devices before surgery can be red flags for someone who may not be a candidate for the outpatient knee replacement.”
“James is unique because he had an inpatient knee replacement years before, and going through this process of having an outpatient knee replacement, he thought it was a lot better for him,” Dr. Reuss continues. “He enjoyed the success and says that his most recent knee replacement is doing better than the one he had done years ago, so he should continue to improve.”
What is Recovery Like After Total Knee Replacement Surgery?
Medical sources affirm that 90% of patients who undergo total knee arthroplasty have considerably less pain afterward. And studies show that 85% of artificial knees continue to function well after 20 years.
After surgery, it is critical to follow a rehabilitation program with a licensed physical therapist to restore strength and flexibility of the knee. After about six weeks, most patients walk comfortably with minimal support, and after muscle strength is reestablished, patients can enjoy most daily activities again.
James credits the entire staff at Orlando Orthopaedic Center for his successful road to recovery. “It’s just been very impressive to me,” says James. “The people here have been very caring and supportive. The physical therapists that were engaged in my recovery have been just outstanding, and I cannot say enough positive things about them.
“Dr. Reuss is excellent and has a great manner. He’s very direct and tells you the story exactly as it is. We had great communication, and you couldn’t go wrong with him. If you’re contemplating this kind of procedure, come and talk to him.”