Outpatient Total Joint Arthroplasty-Can It Be Done Safely? : A Review

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Sarit Hongvilai, MD
Rapeepat Narkbunnam, MD
Christopher S. Mow, MD


Total knee arthroplasty and total hip arthroplasty are one of the most successful procedures treating patients with later stage of osteoarthritis. With an improvement    of patient care, in every step from pre-operation, intra-operation and post operation,  the length of hospital stay is decreasing to a few days and lastly, in outpatient service. We reviewed the current literatures about outpatient arthroplasty, to determine what you should know before doing an outpatient total joint arthroplasty, results and complications.


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Hongvilai S, Narkbunnam R, Mow CS. Outpatient Total Joint Arthroplasty-Can It Be Done Safely? : A Review. BKK Med J [Internet]. 2016 Feb. 19 [cited 2023 Dec. 1];11(1):39. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/221487
Reviews Article


1. Makela KT, Matilainen M, Pulkkinen P, et al. Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database of four nations. BMJ 2014;348:f7592.
2. Ulivi M, Orlandini L, Meroni V, et al. Survivorship at minimum 10-year follow-up of a rotating-platform, mobile- bearing, posterior-stabilised total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014;23: 1669-75.
3. Mertes SC, Raut S, Khanduja V. Integrated care pathways in lower-limb arthroplasty: are they effective in reducing length of hospital stay? Int Orthop 2013;37:1157-63.
4. Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 2008;79:168-73.
5. Yasunaga H, Tsuchiya K, Matsuyama Y, et al. Analysis of factors affecting operating time, postoperative compli- cations, and length of stay for total knee arthroplasty: nationwide web-based survey. J Orthop Sci 2009;14:10-6.
6. Husted H, Lunn TH, Troelsen A, et al. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop 2011;82:679-84.
7. Lovald ST, Ong KL, Malkani AL, et al. Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. J Arthroplasty 2014;29:510-5.
8. Berger RA, Sanders S, Gerlinger T, et al. Outpatient total knee arthroplasty with a minimally invasive technique. J Arthroplasty 2005;20:33-8.
9. Kolisek FR, McGrath MS, Jessup NM, et al. Comparison of outpatient versus inpatient total knee arthroplasty. Clin Orthop Relat Res 2009;467:1438-42.
10. Hayes JH, Cleary R, Gillespie WJ, et al. Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty? J Arthroplasty 2000;15:448-52.
11. Renkawitz T, Rieder T, Handel M, et al. Comparison of two accelerated clinical pathways--after total knee replacement how fast can we really go? Clin Rehabil 2010;24:230-9.
12. Bertin KC. Minimally invasive outpatient total hip arthroplasty: a financial analysis. Clin Orthop Relat Res 2005;435:154-63.
13. Ong PH, Pua YH. A prediction model for length of stay after total and unicompartmental knee replacement. Bone Joint J 2013;95-B(11):1490-6.
14. Horlocker TT. Pain management in total joint arthroplasty: a historical review. Orthopedics 2010 ;33:14-9.
15. Brander VA, Stulberg SD, Adams AD, et al. Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res 2003;416:27-36.
16. Jonas SC, Smith HK, Blair PS, et al. Factors influencing length of stay following primary total knee replacement in a UK specialist orthopaedic centre. Knee 2013;20:310-5.
17. Hansen VJ, Gromov K, Lebrun LM, et al. Does the Risk Assessment and Prediction Tool Predict Discharge Disposition After Joint Replacement? Clin Orthop Relat Res 2014;473:597-601.
18. Lovald S, Ong K, Lau E, et al. Patient selection in out- patient and short-stay total knee arthroplasty. J Surg Orthop Adv 2014;23:2-8.
19. Courtney PM, Rozell JC, Melnic CM, et al. Who Should Not Undergo Short Stay Hip and Knee Arthroplasty? Risk Factors Associated With Major Medical Compli- cations Following Primary Total Joint Arthroplasty. J Arthroplasty 2015; 30:1-4.
20. Raut S, Mertes SC, Muniz-Terrera G, et al. Factors associated with prolonged length of stay following a total knee replacement in patients aged over 75. Int Orthop 2012;36:1601-8.
21. Livbjerg AE, Froekjaer S, Simonsen O, et al. Pre- operative patient education is associated with decreased risk of arthrofibrosis after total knee arthroplasty: a case control study. J Arthroplasty 2013;28:1282-5.
22. Beaupre LA, Lier D, Davies DM, et al. The effect of a preoperative exercise and education program on func- tional recovery, health related quality of life, and health service utilization following primary total knee arthro- plasty. J Rheumatol 2004;31:1166-73.
23. Jones S, Alnaib M, Kokkinakis M, et al. Pre-operative patient education reduces length of stay after knee joint arthroplasty. Ann R Coll Surg Engl 2011;93:71-5.
24. Scott CE, Bugler KE, Clement ND, et al. Patient expecta- tions of arthroplasty of the hip and knee. J Bone Joint Surg Br 2012;94:974-81.
25. Sjoling M, Nordahl G, Olofsson N, et al. The impact of preoperative information on state anxiety, postopera- tive pain and satisfaction with pain management. Patient Educ Couns 2003;51:169-76.
26. Topp R, Swank AM, Quesada PM, et al. The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. PM R 2009;1:729-35.
27. Huang SW, Chen PH, Chou YH. Effects of a preoperative simplified home rehabilitation education program on length of stay of total knee arthroplasty patients. Orthop Traumatol Surg Res 2012;98:259-64.
28. Rodgers JA, Garvin KL, Walker CW, et al. Preoperative physical therapy in primary total knee arthroplasty. J Arthroplasty 1998;13:414-21.
29. Dorr LD, Thomas DJ, Zhu J, et al. Outpatient total hip arthroplasty. J Arthroplasty 2010;25:501-6.
30. Berger RA, Kusuma SK, Sanders SA, et al. The feasi- bility and perioperative complications of outpatient knee arthroplasty. Clin Orthop Relat Res 2009;467:1443-9.
31. Maheshwari AV, Boutary M, Yun AG, et al. Multimodal analgesia without routine parenteral narcotics for total hip arthroplasty. Clin Orthop Relat Res 2006;453:231-8.
32. Dahl JB, Kehlet H. Preventive analgesia. Curr Opin Anaesthesiol 2011;24:331-8.
33. Dalury DF, Lieberman JR, MacDonald SJ. Current and innovative pain management techniques in total knee arthroplasty. J Bone Joint Surg Am 2011;93:1938-43.
34. Hebl JR, Dilger JA, Byer DE, et al. A pre-emptive multi- modal pathway featuring peripheral nerve block im- proves perioperative outcomes after major orthopedic surgery. Reg Anesth Pain Med 2008;33:510-7.
35. Buvanendran A, Kroin JS, Tuman KJ, et al. Effects of perioperative administration of a selective cyclooxygenase 2 inhibitor on pain management and recovery of function after knee replacement: a randomized controlled trial. JAMA 2003;290:2411-8.
36. Mallory TH, Lombardi AV, Jr., Fada RA, et al. Pain management for joint arthroplasty: preemptive analgesia. J Arthroplasty 2002;17:129-33.
37. Choi PT, Bhandari M, Scott J, et al. Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev 2003(3):CD003071.
38. George DA, Sarraf KM, Nwaboku H. Single periopera- tive dose of tranexamic acid in primary hip and knee arthroplasty. Eur J Orthop Surg Traumatol 2015;25:129-33.
39. Bagsby DT, Hur J. Effect of intra-articular injection of tranexamic acid on postoperative hemoglobin in total hip arthroplasty. Orthopedics 2014;37:e557-62.
40. Huang Z, Ma J, Shen B, et al. Combination of Intravenous and Topical Application of Tranexamic Acid in Primary Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. J Arthroplasty 2014; 29:2342-6.
41. Sabatini L, Atzori F, Revello S, et al. Intravenous use of tranexamic acid reduces postoperative blood loss in total knee arthroplasty. Arch Orthop Trauma Surg 2014; 134:1609-14.
42. Li C, Zeng Y, Shen B, et al. A meta-analysis of minimally invasive and conventional medial parapatella approaches for primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014;23:1971-85.
43. Cheng T, Liu T, Zhang G, et al. Does minimally invasive surgery improve short-term recovery in total knee arthro- plasty? Clin Orthop Relat Res 2010;468:1635-48.
44. Tasker A, Hassaballa M, Murray J, et al. Minimally invasive total knee arthroplasty; a pragmatic randomised controlled trial reporting outcomes up to 2 year follow up. Knee 2014;21:189-93.
45. Berger RA. A comprehensive approach to outpatient total hip arthroplasty. Am J Orthop (Belle Mead NJ) 2007;36:4-5.