If you are interested in outpatient total joint replacement, discuss with your surgeon whether you are a candidate for a safe home recovery.
The transition to outpatient total joint replacement (TJR) was made possible by numerous advancements. Surgeries are now typically done with spinal or epidural anesthesia rather than general anesthesia. This helps decrease blood loss during surgery and helps patients be more awake and alert immediately after surgery. It also decreases nausea and vomiting. Pain control methods have improved, with patients often receiving nerve blocks preoperatively, which decreases narcotic usage postoperatively. Surgeons also now typically inject additional long-lasting numbing medication in the deep and superficial tissues at the time of surgery. Oral pain medications after surgery now focus on a “multi-modal” approach, combining non-opioids like Tylenol and NSAIDs, while saving opioid medications as a rescue option.
Surgical technique has improved as well. Operative times have become shorter, which helps decrease blood loss. Another dramatic change came with the introduction of tranexamic acid, a medication that blocks the breakdown of blood clots. Patients receiving tranexamic acid have significantly less blood loss and significantly decreased rates of blood transfusion after surgery. Less blood loss means less IV fluids are given during surgery, which helps the body maintain healthy fluid balances after surgery.
Benefits of outpatient TJR include a more comfortable recovery, as patients can spend the night in their own home. Patients can be mobile sooner and spend less time in bed. A recent study showed that patients are highly satisfied with outpatient TJR, with 93% reporting they would choose the outpatient setting again. Outpatient TJR has also been shown to be safe, with low rates of surgical and medical complications or readmission to a hospital. Still, not every patient is healthy enough for outpatient TJR. Appropriate selection criteria is important. This is evaluated on a case-by-case basis through detailed discussion between patient and surgeon.
If you choose to have outpatient TJR, plan ahead to ensure you have a successful recovery. Pick up your postoperative medications before surgery so they are ready at home. Have other pain-control methods such as an ice machine set up and ready to go. It can help to prepare your home for a short period of first-floor living. Consider setting up a bed as well as anything else you might need to avoid trips up the stairs. Schedule your first physical therapy session to begin within a few days after surgery. Be sure to have a walker and a cane at home to help you maneuver safely in the beginning. Finally, make sure another healthy person can stay with you for the first several days in case of an emergency.
If you are interested in outpatient total joint replacement, discuss with your surgeon whether you are a candidate for a safe home recovery. FBN
By Liam Bosch, M.D.
Dr. Liam Bosch is a fellowship-trained orthopaedic surgeon who brings his expertise in hip and knee replacement to Flagstaff Bone and Joint and cares for patients suffering from arthritis. Additionally, he specializes in conducting revision surgeries for knee and hip implants, addressing any complications that may arise. With a dedication to utilizing cutting-edge techniques, Dr. Bosch offers advanced procedures, such as anterior total hip arthroplasty and robotic total knee arthroplasty. His commitment to providing exceptional care and innovative treatments makes him a valuable asset to Northern and Central Arizona. For further information, please visit: www.flagstaffboneandjoint.com.