OUTPATIENT KNEE REPLACEMENT

OUTPATIENT “FAST TRACK” KNEE REPLACEMENT

A Fast Track Knee is no compromise. It is a true state of the art knee replacement. It’s simply a much better way to have it done. Almost all patients are now up walking within a few hours of knee replacement surgery, and going home the same afternoon, or the following morning at the latest.

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Following years of refinement, Dr. Gautsch performed the first successful outpatient total knee replacement in Tennessee in 2014
from the side — without cutting any of the knee muscles or tendons.

Thousands of patients each year, from throughout TN and all surrounding states, arrange for Dr. Gautsch and his highly-skilled team to perform their surgery at the Indian Lake Surgery Center — more than all other outpatient facilities in the region combined

 

 

The “Southern Approach” Knee Technique:

• Same Day Surgery
• Performed through a side incision
• Cuts no muscles or tendons
• Replaces just the worn knee surfaces
• Allows full weight bearing and walking within hours
• Allows patients to go home the same day
• Accelerated recovery, and Rapid return to function
• Lasts for 25-30 years typically

How is it different?

• High tech, State of the Art, Minimally Invasive, “Super Sub-Vastus” approach
• None of the quad muscle or tendon cutting with the traditional “down the front” incision
• No need for general anesthesia
• Uses Multi-modal Ultrasound Guided, Selective Nerve Blocks with Long-Acting Local Anesthesia and IV sedation — no breathing tubes
• Tourniquet-less surgery, so blood continues to circulate and oxygenate the leg throughout the surgery
• Preserves more of the natural blood supply
• Goes around rather than through significant structures
• Uses Real-time 3D Stereoscopic Digital Data Mapping of the knee
• Uses Virtual Reality Workstation for Modeling and Planning directly in surgery
• Uses Computer Assisted Navigation for precise sizing, knee balancing, positioning and alignment
• Allows weight bearing and exercises to begin immediately, with an Accelerated Therapy Protocol
• Typically achieves normal knee ranges of motion in 2-4 weeks

 

KNEE REPLACEMENT [What is it, really?]

A modern knee replacement procedure is not the “out with the old, in with the new” as most people imagine. Today’s Knee Replacement is a high-tech, high-durability, super-alloy resurfacing procedure that replaces only the damaged surfaces in the knee. Your bone, muscles, tendons, ligaments, and kneecap all remain. It’s not the structure, just the worn surfaces that are renewed. It can be “partial”, just a selected surface, or “total” renewing all of the knee’s surfaces. We routinely do both as an outpatient procedure.

 

A gentler approach, from the side. This minimally-invasive, muscle-sparing approach to the knee takes advantage of a natural interval, behind the quadriceps and in front of the hamstring muscles. It has proven far easier on patients. The common approach, cuts straight down the middle and right through the quadriceps sewing it all back together on the way out. Instead, we don’t have to wait for muscles or tendons to heal, because they are not cut. It’s a more technically-demanding approach for the surgeon, but it is definitely worth it for the patient. Also, a side-incision looks nicer.

 

Computer assisted surgery. It’s practically cheating. The laser-guided 3D stereoscopic digital cameras, virtual reality computer workstation, and infrared digital arrays which we have in our operating rooms quite simply help perform a better knee replacement surgery. With the computer-assisting, we are able to achieve a level of precision down to 0.5 millimeters and 0.5 degrees of perfect alignment. It’s like hitting every shot perfectly, time after time after time.

 

Ultrasound-guided selective nerve blocks. We use new long-acting numbing medicines to selectively block just the pain fibers, leaving the motor nerves to the muscles awake. This allows patients to be up walking within hours of the procedure with minimal discomfort.

 

Tourniquet-less surgery and meticulous hemostasis. Following the principles of William Stewart Halsted, the Johns Hopkins Chief and Father of modern surgery, Dr. Gautsch conducted a long and deep study of the anatomy, and performed several thousand knee replacements without the tourniquet. With careful, gentle treatment of the tissues, avoiding the vessels, tight intra-operative blood pressure control, and newer medications, fewer than one in two hundred replacement patients requires transfusion. Less bleeding and keeping blood flow in the leg during surgery is better, and healthier, for the patient.

Quicker Recovery - A fast-track bonus

The typical “Fast Track” knee replacement patient goes home within four hours of surgery, walks with a walker for just 2 to 5 days, begins driving in the second or third week, and has recovered sufficiently to be able to say “Thank you so much — and good-bye” to us after just five weeks of physical therapy.

Highly Successful - 98%+

Better than 95%. An experienced surgeon, in a modern facility, using computer navigation, with well-proven component designs, coupled with experienced therapists guiding the outpatient physical therapy achieves the highest functional results. According to the US GAO, knee replacement is also the second most beneficial of all surgeries performed in the US. (Cataract surgery is #1).

Few Limitations "What Can and Can't I do?"

Our typical knee replacement patient walks, hikes, gardens, bikes, swims, plays golf and doubles tennis, ride horses, tractors, mowers and four wheelers, hunt in the woods, and climb ladders, deer stands, and stairs essentially like normal. The only things we ask patients not to do is run and jump, not because they can’t, but because it theoretically shortens the lifespan of the knee.

Very Durable "how long do they last?"

More than 98% of the knee replacements we’ve performed over the past 20 years are still functioning well, for those who still need them. Studies have shown that replacements performed by experienced surgeons using computer-navigation during surgery also last the longest. We’ve performed thousands of computer-assisted knee replacements. We’ve also been fortunate enough to see an incredibly low revision rate for our patients.

"So, how do I know when it's time?"

It’s a quality of life question. Most people are ready when they experience more discomfort or limitation than they want to live with, despite arthritis, medications and/or injections. Knee replacement surgery offers the most consistently predictable way to return to comfortable function for most of those suffering with advanced knee arthritis. It’s also the treatment that lasts the longest, by far.