When Same-Day Surgery is Right for You

*Originally posted by American Association of Hip and Knee Surgeons

You may know someone who had hip or knee replacement surgery and went home the same day. In the past, hip and knee replacement surgery required a hospital stay lasting several nights. With advances in procedural techniques, anesthesia medications, pain management and rehabilitation, some people can now have a joint replacement surgery without spending a night in the hospital.

As of now, only a small percentage of people are candidates for outpatient (also referred to as “same-day”) hip and knee replacement surgery. This is expected to grow as surgeons become more experienced in outpatient surgery and techniques for pain management and outpatient care improve.

The Centers for Medicare and Medicaid services (CMS), the government agency that controls payments for the care of Americans who are enrolled in the program, has now authorized total knee replacement surgery to be performed at outpatient surgery centers. Previously these patients were required to stay for a minimum of two nights in the hospital. CMS has also announced that total hip replacement has approval to be performed on an outpatient basis as well.

Advantages of Outpatient Total Joint Replacement

Familiar Environment

  1. You may be more comfortable recovering at home.
  2. You will be in a familiar environment with all the conveniences of being at home and having family to help.
  3. You’ll be able to sleep in your own bed and not be woken up throughout the night by hospital staff for regular checks or from other noises that are part of the hospital environment.
  4. You will be able to eat your own food.

You Control Your Meds
You will be in charge of your pain medication regimen without waiting for medications to be brought to you.

Less Infection Risk
There is less risk of infection by getting out of the hospital environment.

Cost Savings
There is potential cost savings to both you and your hospital. If you have a high insurance deductible or coinsurance payment, you may save a substantial amount of money by skipping the cost of overnight hospital care.

Who can have outpatient joint replacement surgery?

If you are healthy and active with no major or ongoing medical problems, then you might be a good candidate for outpatient surgery.

Typically, younger patients who are walking without assistive devices (like canes or walkers) before surgery and are limited only by a painful hip or knee make good candidates.

Your motivation to get better is a key part of doing well with outpatient joint replacement surgery, and it is very important to keep a positive attitude.

Your orthopaedic surgeon can help you decide if you could be a candidate for outpatient hip or knee replacement surgery.

Who shouldn’t have outpatient joint replacement surgery?

If you have a serious medical issue, then it may be best to stay in the hospital for one or two days after surgery to make sure that your medical problems are stable before you go home.

Patients with medical conditions such as heart disease, congestive heart failure, poorly controlled diabetes, chronic lung disease, chronic kidney disease, sleep apnea, or who take daily steroid medications will most likely not be candidates for outpatient joint replacement surgery.

The same holds true for patients with balance problems or chronic neurologic disease who have had difficulty walking before surgery. Patients who live alone and have no one to care for them at home are also not candidates.

Your surgeon determined you can go home the same day! What’s next?

Getting Ready for Outpatient Joint Replacement Surgery

If you and your surgeon have determined that it is safe for you to have outpatient surgery, it is essential to make plans before the day of surgery. Include your friends and family in the plans – especially those who will be staying with you and caring for you after you return home. A family member or friend can serve as a coach and is an important part of the process as you make plans.

  • Go to the class offered by the hospital or outpatient center where you will have your surgery.
  • Prepare your home: remove loose rugs, board pets, prepare and freeze meals.
  • Plan your care: fill prescriptions, make appointments for nursing care and physical therapy.

Surgery Day

These videos show you what to expect on the day of surgery for hip replacement and knee replacement:

» Hip Replacementmini-posterior and anterior approach

» Knee Replacementtotal and partial

Note that no matter what surgical approach your surgeon uses for hip replacement surgery (posterior, mini-posterior, anterior), it has no bearing on whether you are a potential candidate for outpatient surgery.

After Surgery and Going Home

When your joint replacement surgery is complete, you will spend time in a post anesthesia care unit (PACU). This is an area in the facility that allows you to recover from your surgery. You will work with a therapist or a nurse to get out of bed to a chair and then start walking. If you have stairs at home, this may include practicing walking up and down stairs. Before you are ready to go home, you should:

  • Be safe walking with crutches or a walker
  • Feel good enough to eat solid food and drink liquids with no nausea or vomiting
  • Not have any dizziness or drowsiness
  • Urinate without difficulty before leaving
  • Have stable vitals signs such as blood pressure and heart rate
  • Have pain well controlled with oral pain medicine

Before leaving the facility, you will be given prescriptions for pain medicine and blood thinners. You will also typically be given instructions for activity and wound care and information on whom to contact if you have any problems at home.

For select patients total joint replacement can be safely performed on an outpatient basis; however, not all patients are good candidates. Further scientific research is needed to better understand who will benefit from this the most and what kind of rehabilitation will be most effective. Thus far, most research studies have shown that outpatient joint replacement is safe for the right person with no difference in complications or readmission rates as compared to surgery with a traditional hospital stay. Researchers continue to study outpatient joint replacement and the long-term outcomes after surgery.

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