The Advantages and Disadvantages of Outpatient Knee Replacement

A patient and surgeon may discuss the option of outpatient knee replacement, in which the patient is sent home the day of surgery. Like any medical decision, the decision carries potential advantages and disadvantages.

Possible Advantages of Outpatient Knee Replacement

The goal of outpatient knee replacement is to provide the equivalent or better outcomes as inpatient knee replacement while also reducing costs, increasing patient comfort, and avoiding risks associated with hospital admission.

Proponents of outpatient joint replacement believe it can:

• Improve outcomes. In general, shorter hospital stays lower the risk of postsurgical infection. One study found that joint replacement patients who stayed in the hospital more than 3 days had a higher rate of complications.¹Otero JE, Gholson JJ, Pugely AJ, Gao Y, Bedard NA, Callaghan JJ. Length of Hospitalization After Joint Arthroplasty: Does Early Discharge Affect Complications and Readmission Rates?. J Arthroplasty. 2016;31(12):2714-2725.
• Improve patient satisfaction. Many patients prefer to recover at home. For example, they may sleep better in their own beds and be happier eating familiar foods.
• Decrease medical costs. Costs associated with hospital care are increasing, and many patients are motivated to keep costs down. One study demonstrated that average costs associated with outpatient knee replacement were approximately $8,500 less than those for a knee replacement followed by a 3- to 4-day hospital stay.²Lovald ST, Ong KL, Malkani AL, et al. Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. J Arthroplasty 2014;29(3):510.

Patients and their doctors can decide if the potential advantages of outpatient knee replacement surgery outweigh the potential disadvantages.

Possible Disadvantages of Outpatient Knee Replacement

A potential disadvantage specific to outpatient knee replacement is:

• Less medical supervision. When recovering at home, most patients do not have direct professional medical supervision. This decrease in direct supervision could be a disadvantage in the first day or two after knee replacement surgery.

See Total Knee Replacement Surgery Recovery

Other issues affect all knee joint replacement patients, but are of particular concern to people undergoing outpatient surgery. These issues (listed below) must be anticipated and planned for.

• Discomfort, pain, and nausea. This requires the patient and family to be well educated about how the patient is to take post-surgery medications. Improved anesthesia techniques have made these issues less common.

  See Managing the Pain of Joint Replacement

• Strong social support is required. Similar to an inpatient stay, patients returning home after knee replacement surgery typically require assistance from family, friends or hired help after surgery.
• Limited mobility. For example:
  • The patient and family will need to prepare for more limited mobility the first few days after surgery. Sometimes, resources such as educational videos, smartphone apps, a pre-operative home assessment, and/or walker and stair training by a therapist are available to prepare the patient.
  • Weight-bearing may be challenging, making going to the bathroom and other activities difficult.
  • Nerve blocks used during surgery can wear off slowly, and may make patients more prone to falls, particularly in the first 24 hours after surgery. When a nerve block is utilized, the patient is usually prescribed a temporary knee brace to help prevent falls.
• Postsurgical complications. Surgeons, nurses and anesthesiologists assess all patients for safety prior to discharge home; however, complications can arise at home. Some of these complications can be life threatening.
  • The most common complication after outpatient joint replacement requiring hospital treatment is anemia that is treated with a blood transfusion. In these cases, patients must return to the hospital but typically do not have to be admitted.³Bovonratwet P, Webb ML, Ondeck NT, et al. Definitional Differences of 'Outpatient' Versus 'Inpatient' THA and TKA Can Affect Study Outcomes. Clin Orthop Relat Res. 2017;475(12):2917-2925.^,4Lovecchio F, Alvi H, Sahota S, Beal M, Manning D. Is Outpatient Arthroplasty as Safe as Fast-Track Inpatient Arthroplasty? A Propensity Score Matched Analysis. J Arthroplasty. 2016;31(9 Suppl):197-201.

See Total Knee Replacement Risks and Complications

Knee replacement surgeons work to minimize these concerns by carefully selecting patients for outpatient surgery and making sure the patients are well-educated and well-equipped for home recovery.

See Post-Surgical Knee Replacement Precautions and Tips

Learn which patients are the best candidates for outpatient knee replacement surgery on the next page.