Outpatient Knee Replacement – Boyd W. Haynes III, MD

In the summer of 2010, I worked with a patient to schedule her total knee replacement. The patient was a 52 year-old female who was highly-motivated to return to her normal activity level. In the course of our conversation about her surgery, she jokingly asked me if she really had to stay at the hospital after her surgery. At that point, I had been performing outpatient partial knee replacements for over five years. I had been researching outpatient total knee replacements and found they were being performed at other surgery centers in the country, so I figured someone had to be OSC’s first outpatient total knee replacement patient! She ended up being the first AND she got her wish – her length of stay at the hospital was about 10 hours.
Over the past several years, I have seen many changes occur that made outpatient total joint replacement surgery possible:
• Advancement in surgical techniques
• Incisions are smaller, reducing likelihood of infection
• Improvements in anesthesia allow for rapid recovery, shorter duration of care and the techniques used are more cost-effective.
• Pain management has improved
• We have developed protocols for post-surgery home-health care, including nursing and physical therapy visits. Patients receive the same clinical care at home as they would in a hospital.
• Insurers began to cover it as an outpatient procedure
It has been over four years since I completed the first outpatient knee replacement. After we developed our at-home recovery program for this surgery, we were confident this could be the wave of the future. In my opinion, it was a natural progression to regularly perform the surgery in this manner, allowing patients to recover in the comfort of their own homes. When we explore any new technologies or techniques at OSC, we always make decisions through the lens of, “would I want this for someone in my family?”
Since the first outpatient knee replacement 4 years ago, my colleagues and I have performed many outpatient total knee and hip replacements. We have shared this information by word-of-mouth, marketing in publications and on the OSC website, and by our physicians exploring the option with patients who may qualify.
We take patient selection very seriously. Not every patient who is interested will qualify. We look for patients who are very motivated to return to a higher activity level than they had pre-surgery. We look for someone who is in reasonably good physical condition. It is very important that the patient has a strong support system in their home. Recovering from major surgery is a full-time job, so it is imperative to have an extra set of hands to assist you and eyes to watch over you. We work with a home health company to provide nursing and physical therapy during the at-home recovery period, but they are not in the patient’s home 24 hours a day.
There are several advantages to having this surgery performed on an outpatient basis:
• Less chance of acquiring an infection because patient spends less time in the hospital, and the incision is coated with a skin glue to seal it.
• Less financial burden– outpatient procedures are always less expensive, so depending on the patient’s insurance, out-of-pocket costs will be less.
• There is less burden on the insurance company and on the hospital staff and resources.
• Recovery will be in the comfort of the patient’s home, which means more privacy, their own food and bed.
• Home-health care will be prearranged, so the patient will know what to expect from the Home Health Nurse and Physical Therapist.
As time progresses, we will likely be performing a great number of outpatient joint replacements. It is exciting to glance across the landscape of orthopaedics, see the significant advances made in the past two decades and think about what the future holds for making patient’s lives easier. If you are experiencing significant knee or hip pain, I encourage you to make an appointment at OSC to find out how we can help you.
Boyd W. Haynes III, MD is a fellowship-trained, board certified Orthopaedic Specialist with Orthopaedic and Spine Center in Newport News, Virginia. Dr. Haynes has been voted a Hampton Roads “Top Doc” for 2012, 2013 and 2014. Dr. Haynes’ practice is focused primarily on sports-related injuries and disorders and joint replacements of the hip and knee. Call 757-596-1900 to make an appointment. Visit www.osc-ortho.com to learn more about OSC and Dr. Haynes.