Outpatient TKR?

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Kimgrif

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Hi all!

My sister is going to be undergoing a knee surgery on 01/21/09 that, from what I can tell, is basically going to be a knee replacement without the prosthesis. They'll be shaving and grinding the bones in the joint, straightening her leg, and they'll also be pinning down the tendon that holds the patella in place. (She has problems with her patella dislocating chronically).

They are doing this on an outpatient basis, meaning she'll go home after surgery with a drain in her knee.

I told her I thought she was crazy to be going home so soon, and she told me that the physician's assistant there told her that now TOTAL knee replacements were being done on a same-day, outpatient basis now too. Having just had a RTKR in August, I cannot imagine going home immediately after surgery!

Has anyone else heard of TKRs being done on a same-day, outpatient basis? Does this sound as crazy to anyone else as it does to me?
 
WOW! I'll pass. I couldn't even think straight for the first day with all the (Necessary) drugs for pain. And a couple of days of PT and guided trips to the bathroom. And they watch like a hawk for infection/reaction. IV antibiotic for the first day if I remember correctly. And blood clots, what about watching for bloood clots. I can't wait to hear Jo's take on this one.
 
I had the same problem of chronically dislocating patella (mine was more subluxation) starting in high school. I had about 9 major surgeries. All this lead to the BTKR in June.
What they are probably doing is a lateral release to help in the alignment or a tibial osteomy which is adding a bone graft to the tibial to lift up the patella tendon to a new position to change the alignment and release stress on the kneecap. I was usually in the hospital 2 or 3 days but this was 20 years ago and I am sure they have improved techniques by now and probably so it could be possible to be an outpatient but it would really depend on how much they are doing..

All I can say is to tell your sister to keep her quads strong. IF I had know that I would have been in much better shape

Simon
 
I hope there is someone else in your family that can be there as an advocate for your sister. Hopefully it is a procedure like Simon described, but I would be VERY uneasy about someone who announced that total knee replacements were done as an outpatient procedure. If for no other reason than the risk of infection, I would think you must be in the hospital for a while. You don't even have your drain tubes out in 24 hours!!!
 
Kim, I have heard of same-day surgery with mimimally invasive surgery but don't think I would be thrilled to do it myself. My second knee replacement was minimally invasive and I think I could have easily gone home the next day but not the same one.

Simon, my daughter has the same problem you had in high school. As a senior in high school last year, she had a sublaxation of her knee cap. Luckily, she didn't need surgery and only had to go through physical therapy afterwards. The doctor she saw said that her joints were loose and to be careful. She now constantly complains about both of her knees hurting and wakes up in a lot of pain. I worry that she'll have chronic knee problems. None of us want to see our kids go through any of this! By the way, my problems are all due to trauma and the arthritis that set in afterward so it's not genetic. Karen
 
Well, sadly it's the way of things. Was pretty much inevitable I suppose. I recall my jaw dropping when friend was sent home the day after he had his hernia repaired but another (US) friend had his done a couple of years ago not only as a day case but as an outpatient treatment! In other words, though he was done in a proper OR, he was sent home as soon as he was properly awake!

There's actually no real reason why any surgical patient shouldn't be sent home the same day so long as they meet certain criteria of independence and have someone to look after them. From the infection point of view, they are actually safer in their own home than in hospital. Drains can always be removed by their own doctors or nurses, just like stitches/clips.

Basically, it comes down to one thing - the pressure on beds and on finance! Simply, it's more efficient
and cheaper to keep bed occupancy brief.

Yep - hospitals are businesses, after all!
 
It still creeps me out, Josephine!!! I understand the business end, though. I just thank God we had the insurance that covers a hospital stay. I wouldn't have wanted to be home the first couple of days. Hospitals here LOVE you if you have that good insurance. You are right about the danger of infection in a hospital....there are really SICK people in there sometimes. I appreciated being able to have my surgery in a facility that ONLY does orthopedic surgery. They were wonderful!
 
My poor sister! She had her surgery yesterday. She had a "reconstruction and a realignment" done. Her kneecap kept dislocating, so the tendons holding that in place were pinned down, etc. The surgery was done outpatient. She went to my mom's yesterday rather than her own home as her own home is a 4-level split with way too many stairs. Things were all great for her this morning. She told me, "Yeah, I'm not having ANY of the problems you had, it's all just great!" I was thinking to myself while she was talking to me, "Uh huh...the femoral block hasn't yet worn off..."

Well, I was right. And...she thought she'd been sent home with OxyContin and Vicodin. She was in SUCH pain tonight and I had gone over to visit her. She couldn't understand why she was in so much pain. I looked at her medication bottles and said, "This is Percoset, not OxyContin! Oxycodone is Percoset!" Well, historically for my sister, she's just as well off if she eats a few TicTacs or takes Percoset, same effect for her as far as pain control. So, the femoral block had worn off and all she had was the Vicodin 5/500 to help with her pain. It was NOT good.

She called the doctor and he called in Vicodin 7.5/750 for her. I cannot believe the surgeon did NOT prescribe something like OxyContin to help her through this! I came home and got the remaining two tablets of OxyContin that I had leftover from my TKR and brought them to her. She'll go in tomorrow to get her own script. I certainly hope it helps her. There's no WAY she can even stand the thought of the CPM machine right now with the amount of pain she is in. How do they expect her to do the things she needs to do? I'm so ANGRY!

She's using my PolarCare Kodiak machine, which is helping too, but still...
 
Kim, I'm so sorry to hear that things went this way for your sister. But it 's so good that she has you by her side to help her get the assistance and attention she needs from her doctor. Keep at it! I agree with you that she shouldn't be in such pain. Hang in there....it will get better for her!!
 
So did your sister have a lot of good cartilage they just left in...so she didn't need a prosthesis?

My TKR was almost outpatient, less than 24 hours in the hospital, walked out. But I think that can only be done with "quad sparing" TKRs.

I don't know much about her type of procedure. I did have a tummy tuck once and went home with drains, they weren't a problem.

What is her pain from? With TKRs you have pain mainly from bone cut ache, I hear.

Hollie
 
Hello Kimgriff, Hope your sister is feeling better. I didn't really know what the difference was between Oxicontin and Oxycodone. I found this broken link removed: https://www.camh.net/About_Addiction_Mental_Health/Drug_and_Addiction_Information/oxycontin_straight_talk.html

I am personally glad that I was given the Percocet as I became addicted to them and had to get off them very slowly, I was able to break them up into very small pieces as the months went on. It took me 4 months mind, but there was no way I could have gone cold turkey, the withdrawal symptons were awful. If I had been on the slow release I would have been on them still with no way to reduce them.

Hope she gets the right medication soon!!
 
OxyContin is for moderate to severe pain, Percocet is for mild to moderate pain.

My sister did not have a knee replacement done. She had a chronically dislocating patella (kneecap). They basically did everything to her that I had done when I had my RTKR done, except she didn't get the prosthesis. They shaved the bones to realign her leg, etc.

I'm just angry that she didn't get ANY consideration for the pain she would be in, and I'm appalled that this was done on an outpatient basis. I guess this surgeon will oftentimes send his surgical patients home with a 24-hour catheter, but he left to go out of town yesterday so he didn't do that for my sister. We talked to the surgeon's PA and he told us that the surgeon NEVER prescribes OxyContin, even for his TKR patients (who also are done on an outpatient basis).

I don't care how "good" this surgeon is reported to be, I'll stick with my OS who still goes with the 3-day hospital stay and believes in painkillers for his patients!
 
My poor sister! She had her surgery yesterday. She had a "reconstruction and a realignment" done. Her kneecap kept dislocating, so the tendons holding that in place were pinned down, etc. The surgery was done outpatient. .

OMG!!!! I had this surgery done on both knees in the late 80s (bilateral) and they kept me in the hospital for 2 weeks! Boy, things have sure changed. And they didn't even start PT for a month because I had to keep my legs straight. I was on the morphine pump for about 4 days--I can't imagine why they didn't send her home with better pain control.

On the bright side, once I was past the worst of it (the first week), things went pretty well and fairly quickly and I was pretty much back to normal in a couple months (MUCH faster than a TKR!).

Weezy
 
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