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Outpatient Hip Replacement

Hip replacement surgery is one of the most common orthopedic surgeries performed. It involves the replacement of the damaged hip bone (ball shaped upper end of the femur) with a ceramic ball attached to a metal stem that is fixed into the femur and placing a new cup with a special liner in the pelvis. Traditionally, the surgery was performed with a large, open incision and required the patient to stay in the hospital for several days. With advanced techniques, it is now possible to perform these surgeries on an outpatient basis where the patient is up and walking a few hours after surgery and goes home on the same day. Outpatient hip surgeries use the same implants as traditional surgery but involve a smaller incision and newer exposure techniques when compared to the traditional procedures. This type of surgery is less invasive to the tissues and bones and involves a much shorter hospitalization time where the patient can go home the same day. 

Benefits of Recovering at Home After Surgery

Recovering at home means leaving the hospital setting and getting to recuperate in the comfort of your home. You will progress better in a familiar home environment where you are more likely to receive good care and a good night’s sleep.

Some of the benefits of recovering at home include:

  • Convenience: The convenience of recovering in your home generally makes recovery time easier than an in-hospital stay.
  • Lower cost: Since there are no hospital room charges and related hospital charges, costs are much lower.
  • Reduced stress: You feel isolated in a hospital setting due to lack of social interaction that negatively affects your recovery. At home, family and friends can visit whenever they like and as often as you wish thereby reducing your stress level.
  • Effective recovery: Home recovery is just as effective as in-hospital recovery. In fact, studies have found no significant differences in terms of complications, mobility, or pain in a home recovery.
  • Safer: Home recovery is much safer compared to hospital stay as you are at risk of developing hospital-acquired infection (HAI) in a hospital setting no matter how sterile a hospital environment is.

Indication

Outpatient hip surgeries are mainly targeted at treating the joints damaged by arthritis and injuries. Chronic joint pain due to erosion of cartilage, damage due to accidents and autoimmune diseases, or bone death leading to the destruction of cartilage are also treated with the help of this surgery. 

Procedure

Outpatient hip surgery is designed to allow surgeons to replace the damaged hip bones through a small, minimally invasive approach. The single incision measures around 5 inches compared to 10 to 12 inches for traditional surgery and is usually placed on the outside of the thigh. The approach goes between the muscles and tendons to expose the hip socket and femoral head, similar to traditional surgery, but to a lesser extent. The head of the damaged femur is removed and the hip socket is cleaned. The stem and ball prosthetics are then fitted into the end of the femur and the cup is placed in the acetabulum without cement to achieve a biologic fixation. The hip is then rejoined and the surrounding tissues are brought back to the normal position. As the incision is very small, fewer muscles and tendons are traumatized. 

Postoperative Care and Instructions

After surgery, you will be transferred to the recovery area where you will rest until you are discharged. You will be given pain medications to ease pain. You may have to wear stockings to prevent blood pooling in your legs. You will be able to do light activities within a couple of weeks. You will also be given postoperative instructions, such as:

  • Use of assistive devices for walking, such as cane or crutches
  • Limited weight-bearing activities
  • Suture and dressing care
  • Physical therapy and exercise regimen to improve range of motion and strength muscles
  • Dietary changes and supplements to improve bone health
  • Adherence to prescribed medications
  • Adherence to follow-up appointments to monitor your progress

Advantages of Outpatient Hip Replacement

The benefits of outpatient hip surgery are:

  • Smaller incisions
  • Less scarring 
  • Less blood loss
  • Shorter hospitalization
  • Early return to work
  • Shorter rehabilitation
  • Less tissue trauma

Complications of Outpatient Hip Replacement

Complications are very rare and minimized with an experienced surgeon. Complications in outpatient hip surgeries mostly arise due to difficulty in performing the surgery within the restricted visual field. Some of the complications include tearing of skin and soft tissues, superficial nerve injury, and bone fracture during implant insertions.


Outpatient Total Knee Replacement

What is Outpatient Total Knee Replacement?

Total knee replacement is the surgical treatment for knee arthritis, where the damaged knee is removed and replaced with an artificial knee implant. Traditionally performed as an inpatient procedure, total knee replacement surgery is now being conducted on an outpatient basis, allowing you to go home on the same day of the surgery. 

This is made possible with recent advances such as improved perioperative anesthesia, minimally invasive techniques and initiation of rehabilitation protocols soon after surgery. 

When is Outpatient Total Knee Replacement Suggested?

Outpatient total knee replacement is considered when your vital signs are stable, such as heart and respiratory rate, blood pressure, and temperature. Moreover, you need to be able to maintain pain control with oral medication and tolerate a regular diet before being discharged on the same day of surgery.

Outpatient Total Knee Replacement Procedure

The outpatient procedure is performed using advancements in anesthetic techniques like a femoral regional block that produces a centralized anesthetic effect and does not require a hospital stay for its effects to wear off, like traditional general anesthesia. 

You will be lying on your back on the operating table and a tourniquet is applied to your upper thigh to reduce blood loss. The arthritic knee is approached through small incisions of three-to-four inches (compared to the eight- to twelve-inch-long incision used in the standard open surgical technique), ensuring that the surrounding muscles and tendons are not cut. This facilitates faster recovery. The damaged portions of the femur (thighbone) are trimmed at appropriate angles using specialized jigs and special guides to ensure a perfect fit of the implant. The next step involves the removal of the damaged area of the tibia (shinbone) and the back of the kneecap. 

Custom-implants are created using 3-D modeling from a CT scan. This makes sure that the implant fits securely and requires minimal trimming of the surrounding soft tissues. The femoral component is attached to the end of the femur with bone cement. The tibial component is then secured to the end of the bone using bone cement. Your surgeon places a polyethylene liner that acts as an articular surface between the thighbone, shin implants and the back of the kneecap to ensure smooth gliding movement. With all the components in place, the knee joint is examined for range of motion.

All excess cement is removed and the entire joint is cleaned out with a sterile saline solution to prevent infection. Drains are inserted and the incision is closed. A surgical dressing or bandage is placed. The whole process takes just over an hour. 

What to Expect after Outpatient Total Knee Replacement

Several hours after surgery, you will be discharged from the hospital following a thorough examination to make sure you meet the requirements for discharge such as stable vital signs during exercise, ability to eat and take pain medicine by mouth. You generally have a two- to four-week recovery compared to the two-to-three-months needed to recover from traditional knee surgery. 

Advantages of Outpatient Total Knee Replacement 

The advantages of the outpatient procedure include:

  • Minimal surgical dissection
  • Shorter recovery period
  • Shorter hospital stay
  • Reduced postoperative pain
  • Less blood loss during surgery
  • Increased range of motion after surgery
  • Less damage to surrounding tissues

Outpatient Unicondylar Knee Replacement

What is Outpatient Unicondylar Knee Replacement?

A unicondylar knee replacement, also known as unicompartmental or partial knee replacement, is a procedure to replace a portion of the damaged knee joint with a prosthetic implant to relieve pain and improve function of the knee joint. Traditionally performed as an inpatient procedure, advances in technology have allowed this procedure to be performed in a minimally invasive manner on an outpatient basis allowing patients to go home the same day of the surgery 

Knee Anatomy

The knee is made up of the femur (thighbone), the tibia (shinbone), and patella (kneecap). The lower end of the thighbone meets the upper end of the shinbone at the knee joint. A small bone called the patella (kneecap) rests on a groove on the front side of the femoral end. A bone of the lower leg (fibula) forms a joint with the shinbone. The bones are held together by protective tissues, ligaments, tendons, and muscles. Synovial fluid within the joint aids in smooth movement of the bones over one another. The meniscus, a soft crescent-shaped cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion.

When is Outpatient Unicondylar Knee Replacement Indicated?

The most common indications for outpatient unicondylar knee replacement not amenable to conservative treatment include:

  • Osteoarthritis of the knee joint
  • Skeletal dysplasias (a disorder that causes abnormal bone growth)
  • Avascular necrosis (death of bone in the knee joint due to issues with blood supply)
  • Rheumatoid arthritis
  • Knee deformity with loss of cartilage and pain
  • Injury or fracture of the knee
  • Gouty arthritis
  • Instability of the knee
  • Significant pain, swelling, and stiffness affecting mobility and quality of life

Diagnosis for Outpatient Unicondylar Knee Replacement

A detailed examination with an orthopedic surgeon will confirm whether or not you need an outpatient unicondylar knee replacement, including:

  • Review of medical history to assess general knee health, signs and symptoms, and previous injuries or surgeries
  • Physical examination to assess the range of motion, amount of swelling, disfigurement, and severity of pain
  • Imaging tests such as X-rays to determine the extent of deformity and damage and MRI scans for a detailed evaluation of soft tissues in your knee

What Happens during Outpatient Unicondylar Knee Replacement?

The operation is performed in an outpatient setting under anesthesia. After adequately sterilizing the surgical area, the surgeon makes a small cut to gain access to the affected knee compartment. The supporting structures of the knee are gently moved out of the way and the damaged cartilage and bone tissue from the surfaces of the femur and tibia are removed. Your surgeon prepares these surfaces appropriately to insert specifically sized prosthetic components to your joint. These components are then secured with the use of cement. All surrounding tissues and structures are restored to their normal anatomic position, and the cut is closed with sutures and sterile dressings.

Postoperative Care and Instructions

As it is an outpatient (same-day) surgery, you will be able to leave the hospital on the same day after your anesthesia wears off. Recovery depends on various factors but is generally quick. You will be given postoperative instructions on:

  • Use of assistive devices for walking, such as a cane
  • Limited weight-bearing activities
  • Surgical site care
  • Physical therapy and exercise regimen
  • Maintaining a healthy weight to minimize stress on the joint
  • Adherence to pain medications to keep you comfortable
  • Adherence to your follow-up appointments

What are the Advantages of Outpatient Unicondylar Knee Replacement?

The advantages of an outpatient unicondylar knee replacement procedure include:

  • Minimal surgical incision
  • Shorter recovery period
  • Shorter hospital stays with same day discharge
  • Reduced postoperative pain
  • Less blood loss during surgery
  • Less damage to surrounding tissues

What are the Risks and Complications Associated with Outpatient Unicondylar Knee Replacement?

Outpatient unicondylar knee replacement is relatively a safe procedure, but however, as with any procedure, it does carry some risks, including:

  • Blood clots
  • Infection
  • Bleeding
  • Injury to nerves and blood vessels
  • Leg length discrepancy
  • Fracture
  • Implant loosening
  • Excess bone and scar tissue formation around the artificial knee joint causing reduced mobility