Same-Day Knee Replacements: Beneficial Approach for Many People

Knee replacements are the second-most common surgical procedure done in the United States, and Lehigh Valley Health Network (LVHN) and Coordinated Health's team of orthopedic surgeons performs more total knee replacements than any other provider in the region, using the latest techniques and technologies.

Same-day knee replacements are one of the advantages of referring patients to LVHN, with Thomas Meade, MD, orthopedic surgeon, offering this procedure at the Coordinated Health Allentown facility.

Especially since Medicare began covering knee replacements as an outpatient procedure in 2018, interest has been accelerating.

Meade says the same-day knee replacement is “a tremendously simplified procedure.”

“Patients go directly home from the recovery room,” he says. “They don’t need postoperative lab work and antibiotics. There is not as much intensive physical therapy, and, most important, half of the patients never take any narcotic pain pills due to simplified pain-management protocols.”

Reduced costs – approximately one-third less – are another key advantage.

Same-day knee replacements are minimally invasive.

Unlike traditional methods of the past, there is usually no kneecap dislocation or cutting of tendons. Instead, surgeons rely on natural separations between tissues and bones.

Another significant development is preemptive pain management. “We don’t wait for the patient to have pain after the operation. Instead, we start non-narcotic pre-emptive pain medication 24 hours ahead of the surgery. So the patient never sees the same degree of inflammation or pain,” Meade says.

With fully integrated pre- and postoperative monitoring, a large percentage of knee replacements can now be done as outpatient surgeries, and they’re predicted to account for 60 percent by 2026.

LVHN uses a clinically validated patient selection tool to assess each person's readiness for same-day discharge, and joint placement seminars help educate patients and families on the entire process. Even people with comorbidities or other medical risk factors can be candidates for a sameday procedure if their primary care providers or internists are engaged before the surgery to address and help minimize those risks.

Sometimes, an individual’s home situation, not a medical condition, prohibits a same-day knee replacement. For example, people who live alone and don’t have someone who can be with them during the first few days after surgery will have a safer recovery in the hospital. A multistory home or rural address may be another inhibiting factor.

A big determinant for a successful outcome is the person’s attitude, Meade says. “Patients have to be completely engaged and want to do this. They have to believe in the system, be accountable and have a care partner who gets educated with them. “Outpatient is not only better and safer with less use of narcotics, but there are also fewer complications and it’s cheaper. For all these reasons, I think it’s the way of the future in value-based health care.”