Total knee arthroplasties are one of the most common orthopedic procedures done in the United States today. Not only is it a very common procedure, but it also is an extremely rewarding procedure if done appropriately. Studies have shown that facilities and surgeons that perform a high volume of total knees have higher success rates than facilities or surgeons which perform a low volume of total knees. At Advanced Orthopaedic Specialists, we perform greater than 400 total knees a year and these are done at Physicians’ Specialty Hospital. With an increase in volume, Advanced Orthopaedic Specialists have done everything to make the total knee surgery as seamless as possible. There are certain risks associated with total knees, but Advanced Orthopaedic Specialists have a system in place to minimize these risks as best as possible.
Outpatient total knee replacement is becoming very common across the united states, and Advanced Orthopaedic Specialists has embraced this. Not every patient is a candidate for an outpatient total knee; however, in our practice approximately 10% to 15% of the patients are candidates for this. At Advanced Orthopaedic Specialists, we stratify our patients based on risks. There are typically four groups of patients which we look at as outlined below.
1. Healthy patient with no medical comorbidities such as heart disease, diabetes, obesity, who have a great social support at home, have the ability to be independent the day of the surgery, and live in a major city with a major hospital close by.
2. Patients who have minor medical comorbidities who may not be able to be independent the day of the surgery, and may live in a rural area or may not have good family support at home.
3. The patient with significant medical comorbidities, but desires not to go to formal inpatient rehabilitation facility.
4. A patient with multiple medical comorbidities such as obesity, diabetes, heart disease, who does not have family support at home or is not able to obtain the independence within the first three days to go home.
The patients who fit in the first group are potentially candidates for outpatient total knee replacements. These patients are educated about outpatient total knee prior to the procedure. Their procedure is done in the morning and they start physical therapy approximately one hour after the procedure where they are ambulating with assistance. If they are able to obtain independence (dress themselves, get in and out of bed on their own, and ambulate 25 yards), they are considered to be independent.If these patients also are medically stable as manifested by stable vital signs consisting of blood pressure, heart rate, and oxygen saturation, have a stable blood count and exhibit no signs of any blood clot they may be a candidate to go home. Our criteria for outpatient total knee is somebody who is independent, is medically stable, exhibits that they do not have a blood clot as evident on an ultrasound done post-operatively, and has good family support and is not living in a rural area. If patients meet all these criteria, they are candidates to go home. If they are discharged home, they are given a hotline number to call should they experience any issues. They will start physical therapy in an outpatient setting the day after the surgery. They will be discharged home with pain medication, strict instructions on wound care, and instructions on signs and symptoms to watch for, for any medical issues.
In the past year, Advanced Orthopaedic Specialists has performed approximately 40 to 50 outpatient total knees with no complications noted. This is a great aspect of our practice, which allows patients to undergo a major surgery safely and to sleep in their own bed in their own home the night of the surgery.
If you feel you are a candidate for a total knee or an outpatien
t total knee, please contact Advanced Orthopaedic Specialists.
Written by Christopher A. Arnold, M.D.