Knee replacement no longer requires a multi-day hospital stay. For appropriately selected patients, the surgery can be performed in an outpatient setting with same-day discharge. You walk, meet discharge criteria, and go home hours after surgery.
Stanford Fellowship-Trained30+ PublicationsLong Beach & Greater LAVirtual Second Opinions
Dr. Leo Zalikha performs outpatient knee replacement at the Surgery Center of Long Beach. Using robotic-assisted technology and a modern pain management protocol, he creates the conditions that allow patients to mobilize early and recover comfortably at home.
Who Qualifies for Outpatient Knee Replacement?
Same-day knee replacement is appropriate for patients who are:
In good general health: No poorly controlled cardiac, pulmonary, or metabolic conditions
At a reasonable body weight: Lower BMI is associated with smoother same-day recovery
Motivated for early mobility: Willing to get up, walk, and work with the physical therapist on surgery day
Supported at home: A responsible adult must be available for the first 24 to 48 hours
Undergoing primary knee replacement: Most outpatient candidates are having a first-time total knee replacement or partial knee replacement
Dr. Zalikha assesses candidacy during the pre-operative evaluation. The decision is individualized. Some patients are strong candidates for same-day surgery. Others are better served by an overnight stay, and that option is always available. Further reading: Are you a candidate for outpatient knee replacement?
What Makes Same-Day Knee Replacement Work
The day-of-surgery experience for outpatient knee replacement is designed for efficiency and comfort:
01. Modern Pain Management
The biggest barrier to early discharge after knee replacement used to be pain control. Today, a multimodal approach combines:
- Regional nerve blocks (adductor canal block and, in some cases, additional blocks) that numb the knee area
- Local anesthetic injected into the tissues around the joint during surgery
- Scheduled oral pain medications started before surgery
- Anti-inflammatory and non-opioid medications to minimize opioid use
This protocol allows most patients to be comfortable and functional within hours of surgery, which is essential for meeting discharge criteria.
02. Robotic Precision
Robotic-assisted knee replacement contributes to outpatient success by improving the accuracy of bone cuts and implant placement. Precise surgery means less soft tissue trauma, less swelling, and more predictable early recovery.
03. Pre-Operative Optimization
Patients who prepare their bodies for surgery recover faster. Dr. Zalikha's pre-operative program focuses on strengthening exercises, nutrition, medical optimization, and setting realistic expectations for recovery day.
What Surgery Day Looks Like
Morning:
Arrive at the Surgery Center of Long Beach. The anesthesia team administers a spinal block and sedation. Surgery takes approximately 60 to 90 minutes.
Midday:
After a recovery period, the physical therapist assists you with standing, walking, bending the knee, and navigating stairs. The team monitors your pain level, vital signs, and readiness for discharge.
Afternoon/Early Evening:
Once discharge criteria are met (safe walking, adequate pain control, stable vitals, tolerance of food and fluids), you go home with your support person. If any criteria are not met, an overnight stay is arranged.
At Home:
You follow the prescribed medication schedule, apply ice, elevate the leg, and perform the exercises demonstrated by the physical therapist. The surgical team is available by phone. A follow-up visit is scheduled within two weeks.
Is It Safe?
Published data on outpatient knee replacement shows that complication rates in properly selected patients are comparable to inpatient surgery. In some studies, readmission rates and complication rates are actually lower in outpatient cohorts, likely because patients are selected carefully.
The critical point is patient selection. Dr. Zalikha does not offer outpatient knee replacement to patients who are not appropriate candidates. Safety is not compromised for convenience.
Outpatient vs. Inpatient: The Same Operation
The surgery is identical regardless of setting. The implant, the robotic planning, the surgical technique, and the wound closure are the same. The only difference is where you spend the first night.
Inpatient recovery provides 24-hour nursing access, on-demand medication, and inpatient physical therapy. Outpatient recovery offers the comfort and familiarity of home. Both paths lead to the same long-term outcome.
Cost & Insurance: What Should You Expect to Pay?
Medicare's national averages for an outpatient total knee replacement (CPT 27447) are $14,275 in a hospital outpatient department and $10,552 in an ambulatory surgery center [1]. Coverage itself is settled policy: Medicare has paid for total knee replacement in the hospital outpatient setting since 2018, and in approved ambulatory surgery centers since 2020 [2][3]. But here is the detail I make sure my patients see before they assume the surgery center is automatically the bargain: under Original Medicare, the average patient share is actually slightly higher in the surgery center — about $2,109 versus $1,967 at the hospital outpatient department — even though the total cost is roughly $3,700 lower [1]. The setting that saves the system money is not automatically the setting that saves you money.
With commercial insurance, the honest difference is more modest than much of what you will read online: a 2023 analysis of US commercial claims found outpatient knee replacement cost about $2,300 less than inpatient surgery at the time of the procedure [4]. That is a real saving, not a windfall — and your deductible, coinsurance, and supplemental coverage usually matter more than the setting itself. Ask for an estimate based on your specific benefits before you schedule, and for the full picture see our guides to knee replacement cost in California and Medicare coverage for knee and hip replacement.
References
[1] Procedure Price Lookup: Total knee arthroplasty (CPT 27447), national average costs in hospital outpatient departments and ambulatory surgical centers. Medicare.gov, U.S. Centers for Medicare & Medicaid Services (accessed June 11, 2026).
[2] Centers for Medicare & Medicaid Services. CY 2018 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS-1678-FC). CMS.gov fact sheet, November 1, 2017.
[3] Centers for Medicare & Medicaid Services. CY 2020 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS-1717-FC). CMS.gov fact sheet, November 1, 2019.
[4] Mantel J, Ruppenkamp JW, Cantu M, Holy CE. Total knee arthroplasty in the outpatient vs inpatient settings: impact of site of care on early postoperative economic and clinical outcomes. J Orthop Surg Res. 2023;18(1):273. PMID: 37013560.
FAQ
Frequently Asked Questions
No. The recovery process is the same. Some patients actually prefer being at home, where they can control their environment, sleep in their own bed, and move at their own pace. The key is having adequate support and following the post-operative plan.
If you or the care team have any concerns about discharge safety, you stay overnight. No questions asked. Patient safety always takes priority.
Yes. Outpatient knee replacement is covered by Medicare and most private insurance plans. The outpatient setting often results in lower total costs.
Yes. Partial knee replacement is actually an excellent outpatient procedure because it is less invasive than total knee replacement. Most partial knee replacement patients go home the same day.
Yes. Medicare has paid for total knee replacement in the hospital outpatient setting since 2018 and in approved ambulatory surgery centers since 2020. Outpatient surgery is billed under Part B rather than Part A, and whether the outpatient setting is right for you is a medical decision your surgeon makes based on your health, not a billing preference.
Less than many websites claim. A 2023 study of US commercial insurance claims found outpatient knee replacement cost about $2,300 less than inpatient surgery at the time of the procedure, and Medicare's national averages show a roughly $3,700 gap between hospital outpatient departments ($14,275) and ambulatory surgery centers ($10,552). The savings are real, just more modest than the five-figure claims you may see online.
Not always. Under Original Medicare, the national average patient copay for an outpatient knee replacement is slightly higher in an ambulatory surgery center ($2,109) than in a hospital outpatient department ($1,967), even though the total cost of care is lower in the surgery center. Your own share depends on your plan and any supplemental coverage, so ask for an estimate based on your specific benefits before scheduling.
Ready for answers about your hip or knee? Request an appointment with Dr. Zalikha.
