(...) staggers me how they think this surgery can be done asan outpatient. I can’t believe people are going home the same day or next day and that they don’t have strong pain meds.
I had my TKR as an outpatient surgery in last February, and it was fine. I was their "pilot project" - it had not been done here until then. They set three conditions for same-day discharge: First, I had to be able to use the bathroom. Second, I had to have eaten a meal. And third, I had to be able to go up and down a staircase (because I have one at home). I arrived at the hospital at 6 a.m. and was the first patient on the surgeon's list for the day. Had the operation at 8 a.m. Had lunch at about 1:30 p.m. (juice, sandwiches, cookies), followed by a visit from the PT, who got me out of bed and using the walker. I was able to get dressed (on my own, including shoes and socks) at around 3 p.m., did the stairs shortly afterwards, and had a visit from the surgeon and anesthesist to make sure everything was ok. They e-mailed my pain med prescriptions to my husband, who went and filled them, then came to collect me at around 6 p.m., and I ate dinner sitting at the table with the family that evening. I was able to go upstairs to bed unaided.
Here in Canada, the entire process, including pre-surgery exams and tests, PT and all follow-up, including medications, is paid for by the State system, so it's essentially free for the patient, who has nothing to pay and no insurance claims to manage. The morning after surgery, I was visited at home by a district nurse, who checked the dressing and made sure I was taking my pills. Then the PT came and showed me some gentle exercises. In the two weeks following the surgery, I had three more visits from nurses (the last one was to remove the dressing) and four more visits from the PT. I then started going to the PT unit at the local hospital. I also had 24-hour access to a resource at the hospital where I had the operation, in case I had questions.
I will say that pain management was challenging. I was prescribed Oxycodone, but I knew after a couple of days that it wasn't right for me: I was a depressed, zombie-like, weepy mess. The surgeon had also prescribed Tramadol as a "Plan B", so I tried that, but it made me feel sick. In the end, after a week or so, I quit all the meds except Tylenol, plus one Tramadol at night to help me sleep. It hurt more, but I was better able to cope with the pain. It was about a month before I felt comfortable.
Before the surgery I adapted my home to give me some independence: for example, I added a shelf to my walker, so I could transport drinks and meals on it, and I organized a backpack so I could carry my phone, computer and medications up and down the stairs. I also did exercises to strengthen my leg, and I practised things like putting on socks and shoes without bending my leg, so I would be independent. If I had to do this again, I would definitely do it as an outpatient surgery. It was wonderful to be able to eat what I wanted, when I wanted, and to be in my own home with my family and dogs.