Dr Loffredo has developed a total knee replacement program at United Memorial Medical Center that allows for patients to return home the same day as their total knee replacement surgery. This is made possible by systematically following a three phase approach to total knee replacement surgery.
PHASE I - Preoperative
- Prehabilitation training program: Studies have shown patients benefit from participation in prehabilitation. Dr Loffredo has a 4 week prehabilitation training program that focuses on strengthening your upper body, core, and lower extremities. After surgery the muscles in your operative extremity will be weak for a period of time. Therefore, strengthening those muscles prior to surgery will allow you to function better immediately post operatively.
PHASE II - Day of Surgery
Dr Loffredo has a multifaceted approach to allowing patients the ability to return home the same day of surgery.
- Preoperative cocktail: The day of surgery you will receive medications prior to surgery which will minimize post operative swelling and pain
- Robotic assisted total knee replacement: the robotic assisted total knee replacement surgery allows Dr Loffredo the opportunity for a minimally invasive incision when possible and real time feedback on soft tissue balancing and alignment. This information allows the surgeon to accurately position the total knee components.
- Post operative pain management (non-narcotic): Intra operatively patients receive an injection of local anesthetic into the knee joint capsule. Dr Loffredo will also place a small catheter within the knee joint which will deliver a continuous drip of local anesthetic into the knee joint. This device is called the on-Q-pump which will allow you the ability to receive local anesthetic for up to 3 days post operatively and the ability to adjust your level of medication received.
- Our physical therapists will be working with you post operatively the day of surgery to get you back on your feet. They will provide you with the guidelines and education necessary to have a successful post operative course.
PHASE III - Post operative
- A physical therapist will visit you in your home 2-3 times per week to work with on post operative stretching and strengthening exercises.
- A combination of pain medications in addition to the On-Q-Pump will allow you to control your post operative knee pain.
- Cryotherapy: usage of cold packs or an ice machine in the immediate post operative days are your friend, especially following physical therapy
- The On-Q-Pump is removed by the patient or family member on post operative day #3. Please remember do not place the ice pack directly over the pain pump to avoid freezing of the medication in the catheter.
- Most patients will rely heavily on the assistance of a walker for transferring from sitting to standing along with ambulation for the first 4 days post operatively. It is important to have a social support network in place for the first post operative 1 week to aide in ADLs (activities of daily living).
- Patients will not be cleared to drive until 6 weeks post operatively on average.
Who is a candidate for same day total knee replacement surgery?
Relative guidelines have been established for outpatient (same day) total knee replacement surgery
- Age: 65 years old or younger
- Healthy older patients with a strong social support can still achieve good outcomes with outpatient surgery when properly prepared
- Weight: body mass index < 35
- Diabetic patients: hemoglobinA1c < 8.0
- Substance abuse: No nicotine (cigarettes) or alcohol dependence
- No history of previous opioid (narcotic) usage for chronic pain (poor prognostic indicator)
- Minimal medical co-morbidities
- No end stage diseases: ex. (Dialysis patients, patients requiring home oxygen, Severe Cardiac or Pulmonary Disease)
- Patients that ambulate at baseline (preop) without an assistive device: ex. walker, cane, or wheelchair
- Patients must have the ability to follow instructions:
- No cognitive impairments: ex. Alzheimer's dementia, Parkinson's disease, vascular dementia (History of multiple strokes)
What is important to note that you may not qualify for outpatient (same day) total knee surgery, but still many of our patients that follow this three phase protocol will be discharged home the following day after only one night in the hospital.