TKR TKR Outpatient?

[Kris_MN]

Hello!

I am 53 and having my right knee replaced in December. I was very surprised to find out that it is outpatient surgery. When I had my left knee replaced in 2016 I spent two nights in the hospital. I’m curious how others have handled the surgery being outpatient? Has the surgery changed that much in 7 years or is it just an insurance thing?

Thank you!

 

[mendogal]

I have had both my TKAs this year as an outpatient (as I'm a senior on Medicare, for the first it was done in the hospital OR with a bed hold in case I couldn't go home; there was no doubt about scheduling my second in the outpatient building).
One thing that has become more common is the use of a spinal plus very short acting iv meds (most commonly here in northern Calif is a combo of Versed and fentanyl; on my most recent TKA we skipped the Versed because it can be risky with seniors). The short acting iv meds let me be eating, drinking, and walking the hall and to the bathroom with my walker within an hour of arriving in the recovery room.
It wasn't the most comfortable hour long ride home, but it was wonderful to be home with my own food, ice machine, recliner, pillows, bathroom, spouse, and cats!!!

 

[Layla]

Hello Kris!
Welcome back to BoneSmart and the Knee side of the forum. I am sure you'll receive many responses from those that experienced out patient joint replacement sharing their opinions.
I will leave you some pre-op reading along with best wishes for all, especially for your comfort as you await your date. I will be following your journey!

KNEE PRE-OP ARTICLES
Score Chart: How bad is my arthritic knee?
Longevity of implants and revisions: How long will my new joint last?

If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:
Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery
Pre-Op Interviews: What's involved?

Regardless of where you are in the process, the website and app My Knee Guide can help you stay organized and informed. The free service keeps all the information pertaining to your surgery and recovery in one place on your smartphone. It is intended to be a personal support tool for the entire process.

And if you want to picture what your life might be like with a replaced knee, take a look at some stories of amazing knee recoveries
@Kris_MN

 

[benne68]

Hi @Kris_MN and welcome back!

Scheduling knee and hip replacements as outpatient surgery has become the norm for a variety of reasons. However, as my surgeon explained to me, for insurance purposes, the term "outpatient" simply means that you are at the hospital for less than 24 hours.

In my case, I was kept overnight because my BP was low and they wanted to monitor me. But, mine was still considered outpatient surgery because -- even though I was in a hospital bed overnight -- I was discharged within 24 hours of my surgery. (Insurance rules are crazy, aren't they?)

That said, your medical/surgical team will not discharge you until you are stable, your pain is controlled and you are able to pass the PT requirements. Just be sure to let them know how you are doing and you will be fine.

 

[Cyclegal]

As much as I love my home sweet home, I opted for overnight stay which my surgeon encourages, and I think was better for me. I had a spinal, nerve block and sedation, and have no memory except waking up in recovery.

I had an IV through the night, and a foley catheter, which was a godsend, I would have been up to the bathroom a zillion times. When the nerve block wore off and I was miserable I got a bit of rapid onset narcotic (dilaudid). I had a drain that was pulled in the morning, so that likely reduced some swelling.

My husband got a nice break, if only for one night.

Pros and cons each way.

Liz

 

[raylo]

I had my Sept 28 TKR at an outpatient facility. I wouldn't do it any other way. Better to just get home into your recovery space and not have to spend a night or 2 in a hospital and then have to make a painful move. Just make sure to have some early wellness checks, which are generally provided by the home PT.

 

[benne68]

I'm glad that worked well for you, @raylo. It does for many, but some people have issues -- whether it's low blood pressure, bleeding, pain management, recovering from general anesthesia -- that really do require an overnight stay.

We are all different and need to do what is right for each of us.

 

[raylo]

Oh, for sure. Hopefully the surgeon would identify most folks who would require or could benefit from a hospital stay ahead of time, but there will surely be some cases where outpatient changes to inpatient after the procedure. One issue I encountered is that when I reported preop that I had BPH and retention issues and told them that I might have a lot of difficulty being able to urinate after the spinal they switched plans from the spinal to general anesthesia. Otherwise, with my late surgery, I might have had to be transported to a hospital... or at least get catheterized. I have had general before and had no issues then or this time.

I'm glad that worked well for you, @raylo. It does for many, but some people have issues -- whether it's low blood pressure, bleeding, pain management, recovering from general anesthesia -- that really do require an overnight stay.

We are all different and need to do what is right for each of us.

 

[Susie-Q]

Hi @Kris_MN , welcome!

I had my first TKR 13 years ago and spent 2 nights in the hospital. I was put under general anesthesia. It made me sick, which was perfectly timed to when my kids came to visit me right after I'd had dinner. (note to the hospital: don't feed post-op patients spaghetti with meatballs after surgery!!! ).

My second TKR was 2 years ago and was outpatient. I had a spinal and propofol. After recovery, I left the hospital around dinner time with a nerve block in my left thigh. It was attached to a ball of medicine that I carried around for about 4 days that slowly dispensed pain meds directly to the nerves in my knee. I was a little worried about going home so soon but it all turned out ok.

Good luck with your upcoming surgery, it will be here before you know it!

 

[JulesOA]

I’m also 53. Both of my TKRs (last year and last month) were done as outpatient procedures. My surgeon gave me the option of outpatient or one night in the hospital. He felt I was healthy enough to have that choice. I wasn’t able to have much time off work, and I live with my husband, so I have support at home, so I was quite comfortable coming home the same day, and really preferred being back home.
My sister-in-law had her TKR last year and spent one night in the hospital and did not have a good experience. Pain meds were not given on schedule, rather, they waited until she was in a lot of pain before they would give them. That is counter to what my surgeons have always told me, don’t wait until the pain is back, take your pain meds when they are due.
Whatever you decide to do, good luck with your upcoming procedure. I am now 4 1/2 weeks post op and doing great.

 

[benne68]

Best wishes for your surgery tomorrow, @Kris_MN.

Look forward to seeing you in the Recovery Forum when you feel up to it!

 

[Tgmaine]

I am having my LTKR on January 4th. For the first, seven years ago, I stayed at the hospital 2 nights because I had an episode of low blood pressure and lots of nausea. This time I am also opting for a one night hospital stay. I am having the spinal with full sleep instead of a general, and hoping the nausea will be less or not at all. My doctor agreed that I need and want professional care that night. I'm coming home to an active dog and a husband who wants to help but has little nursing patience. And I have to climb 12 steps to go to bed. Maybe some other women will understand that we don't get meals served to us very often . I will be at home with home health for several weeks. I'm in no hurry.

 

[Susie-Q]

a husband who wants to help but has little nursing patience.

I had one of these as well..... I was hoping that taking over all of my duties that I do every day (dog, cat, meals, dishes, housework) would lead to a little appreciation for all I do but it really only led to frustration for both of us. I wish you luck and patience.