Management of patients undergoing same-day discharge primary total hip and knee arthroplasty

• Same-day discharge total hip and knee arthroplasty is becoming more common, made feasible by perioperative advances such as minimally invasive surgical approaches, the use of tranexamic acid and multimodal and pre-emptive analgesia.

• According to protocols developed to ensure patient safety, candidates for same-day surgery are people younger than 80 years without preoperative bleeding disorders, cirrhosis, clinically important cardiac disease or end-stage renal disease.

• When patients are selected appropriately, rates of adverse events and functional outcomes are similar to those observed among patients who undergo inpatient-protocol arthroplasty, patient satisfaction is high, and procedures are cost-effective.

• Careful education of patients, by surgeons and primary care physicians, can help to dispel myths about outpatient total joint arthroplasty and thereby optimize success.

Total hip arthroplasty and total knee arthroplasty are established procedures for the effective treatment of complications of advanced arthritides or avascular necrosis. With new surgical techniques and approaches to perioperative care, the average length of an inpatient stay associated with these procedures has decreased in recent years.¹ The demand for primary total hip and total knee arthroplasty in patients younger than 65 years has been projected to increase by more than 50% by 2030.² With the annual frequency of these procedures already rapidly increasing owing to an aging population, same-day discharge arthroplasty may be a feasible solution to the increased pressure to decrease health care costs.³

We review observational and interventional research on the effectiveness of same-day discharge total hip and total knee arthroplasty (Box 1). In this review, same-day discharge arthroplasty refers to protocols that see patients discharged home on the same calendar day as the procedure, usually within 4 to 8 hours after the end of the surgery. This is distinct from discharge within 23 hours after surgery, which is often labelled as “outpatient” in the literature. However, many large database studies do not distinguish between the 2 kinds of protocols, and some evidence presented herein includes patients who spent up to 23 hours in hospital.