Reemplazo Ambulatorio de Cadera o Rodilla

¿Es un reemplazo de cadera o rodilla de corta estadía adecuado para usted?

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La cirugía ambulatoria de reemplazo de cadera o rodilla, también conocida como artroplastia total de la articulación (TJA), ahora se realiza en centros seleccionados y en pacientes seleccionados que están lo suficientemente saludables como para ser candidatos. Estas cirugías pueden realizarse en un centro de cirugía ambulatoria o en un hospital. Los cirujanos ortopédicos están de acuerdo en que la TJA ambulatoria solo debe realizarse en pacientes que estén lo suficientemente sanos como para someterse a este tipo de cirugía y ademas tengan el apoyo adecuado en el hogar para permitir que sean dados de alta de esta manera. Este concepto es nuevo y los cirujanos ortopédicos aún están clarificando cómo maximizar los beneficios de esta idea para los pacientes.

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Familiar Environment

You may be more comfortable recovering at home.
You will be in a familiar environment with all the conveniences of being at home and having family to help.
You’ll be able to sleep in your own bed and not be woken up throughout the night by hospital staff for regular checks or from other noises that are part of the hospital environment.
You will be able to eat your own food.

You Control Your Meds

You will be in charge of your pain medication regimen without waiting for medications to be brought to you.

Less Infection Risk

There is less risk of infection by getting out of the hospital environment.

Cost Savings

There is potential cost savings to both you and your hospital. If you have a high insurance deductible or coinsurance payment, you may save a substantial amount of money by skipping the cost of overnight hospital care.

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Who can have outpatient joint replacement surgery?

If you are healthy and active with no major or ongoing medical problems, then you might be a good candidate for outpatient surgery.

Typically, younger patients who are walking without assistive devices (like canes or walkers) before surgery and are limited only by a painful hip or knee make good candidates.

Your motivation to get better is a key part of doing well with outpatient joint replacement surgery, and it is very important to keep a positive attitude.

Your orthopaedic surgeon can help you decide if you could be a candidate for outpatient hip or knee replacement surgery.

Who shouldn't have outpatient joint replacement surgery?

If you have a serious medical issue, then it may be best to stay in the hospital for one or two days after surgery to make sure that your medical problems are stable before you go home.

Patients with medical conditions such as heart disease, congestive heart failure, poorly controlled diabetes, chronic lung disease, chronic kidney disease, sleep apnea, or who take daily steroid medications will most likely not be candidates for outpatient joint replacement surgery.

The same holds true for patients with balance problems or chronic neurologic disease who have had difficulty walking before surgery. Patients who live alone and have no one to care for them at home are also not candidates.

Your surgeon determined you can go home the same day! What’s next?

Getting Ready for Outpatient Joint Replacement Surgery

If you and your surgeon have determined that it is safe for you to have outpatient surgery, it is essential to make plans before the day of surgery. Include your friends and family in the plans – especially those who will be staying with you and caring for you after you return home. A family member or friend can serve as a coach and is an important part of the process as you make plans.

Go to the class offered by the hospital or outpatient center where you will have your surgery.
Prepare your home: remove loose rugs, board pets, prepare and freeze meals.
Plan your care: fill prescriptions, make appointments for nursing care and physical therapy.

Surgery Day

These videos show you what to expect on the day of surgery for hip replacement and knee replacement:

» Hip Replacement – mini-posterior and anterior approach

» Knee Replacement – total and partial

Note that no matter what surgical approach your surgeon uses for hip replacement surgery (posterior, mini-posterior, anterior), it has no bearing on whether you are a potential candidate for outpatient surgery.

After Surgery and Going Home

When your joint replacement surgery is complete, you will spend time in a post anesthesia care unit (PACU). This is an area in the facility that allows you to recover from your surgery. You will work with a therapist or a nurse to get out of bed to a chair and then start walking. If you have stairs at home, this may include practicing walking up and down stairs. Before you are ready to go home, you should:

Be safe walking with crutches or a walker
Feel good enough to eat solid food and drink liquids with no nausea or vomiting
Not have any dizziness or drowsiness
Urinate without difficulty before leaving
Have stable vitals signs such as blood pressure and heart rate
Have pain well controlled with oral pain medicine

Before leaving the facility, you will be given prescriptions for pain medicine and blood thinners. You will also typically be given instructions for activity and wound care and information on whom to contact if you have any problems at home.

For select patients total joint replacement can be safely performed on an outpatient basis; however, not all patients are good candidates. Further scientific research is needed to better understand who will benefit from this the most and what kind of rehabilitation will be most effective. Thus far, most research studies have shown that outpatient joint replacement is safe for the right person with no difference in complications or readmission rates as compared to surgery with a traditional hospital stay. Researchers continue to study outpatient joint replacement and the long-term outcomes after surgery.

Other Resources from AAHKS

» Setting Expectations

» How to Get the Most Out of Your Total Joint Replacement

» Good Health = Good Recovery After Surgery

January 2020

This article has been written and peer reviewed by the AAHKS Patient and Public Relations Committee and the AAHKS Evidence Based Medicine Committee. Links to these pages or content used from the articles must be given proper citation to the American Association of Hip and Knee Surgeons.