JOA - 2026-08-24 - Journal Article
Outpatient and Early Discharge Revision Total Joint Arthroplasty: A Systematic Review and Pooled Quantitative Analysis.
Hiatt JL, Ricciardelli ZM, Schwab JM, Baker CC, DeCook CA, Naylor BH
Topics
Key Takeaway
In selected low-comorbidity patients undergoing predominantly low-complexity revision procedures, outpatient rTKA and rTHA achieved PJI rates of 9.0% vs 13.0% (p<0.001) and transfusion rates of 6.2% vs 21.9% (p<0.001) compared to inpatient cohorts.
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Summary
This systematic review and pooled analysis compared outpatient/accelerated discharge versus inpatient revision TKA and THA across 14 studies to assess safety and patient selection criteria. Outpatient rTKA patients had significantly lower BMI, lower CCI, and higher proportions of ASA I/II (91.7% vs 50.2%, p<0.001), and predominantly underwent polyethylene exchanges rather than complex reconstructions. Medical complication rates were lower or equivalent in outpatient cohorts for both rTKA and rTHA, with outpatient rTHA demonstrating markedly lower transfusion rates (6.2% vs 21.9%, p<0.001).
Key Limitation
Profound selection bias — outpatient cohorts were systematically healthier and underwent less complex procedures — makes direct complication rate comparisons between inpatient and outpatient groups unreliable as a true safety equivalence assessment.
Original Abstract
BACKGROUND
Revision total joint arthroplasty (rTJA) volumes are rising in parallel with the rapid migration of arthroplasty to ambulatory surgery centers. Despite this shift, evidence defining the safety, outcome, and appropriate patient selection for outpatient rTJA remains limited.
METHODS
A systematic review and pooled quantitative analysis were performed to compare inpatient and outpatient/accelerated discharge rTJA. Studies reporting patient demographics, revision types, surgical indications, comorbidities, and complications following revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA) were included. There were 14 studies that met the inclusion criteria, with 11 eligible for quantitative synthesis.
RESULTS
Outpatient rTKA patients were healthier, reflected by lower mean body mass index (BMI), lower mean Charlson Comorbidity Index (CCI) score, and more American Society of Anesthesiologists (ASA) classes I or II patients (91.7 versus 50.2%; P < 0.001). Outpatient rTKA patients commonly underwent less complex procedures such as polyethylene exchanges. Postoperatively, rTKA outpatients demonstrated lower or similar rates of all medical complications compared with inpatients, including periprosthetic joint infection (PJI) (9.0 versus 13.0%; P < 0.001). The outpatient rTHA cohort also had a lower mean BMI, lower mean CCI score, and more ASA classes I or II patients (73.6 versus 49.5%; P < 0.001). Outpatient hip revisions appeared to more commonly involve lower-complexity procedures, including head/liner exchanges. Reported outpatient rTHA medical complication rates were generally comparable to inpatient cohorts, although interpretation is limited by smaller sample sizes and variable reporting across studies. Notably, transfusions were lower in the outpatient rTHA cohort (6.2 versus 21.9%; P < 0.001).
CONCLUSION
In appropriately selected patients, outpatient rTKA and rTHA appear to represent a safe alternative to traditional inpatient care. These findings reinforce the importance of surgeon-driven patient selection and support the continued expansion of outpatient rTJA in the setting of evolving policy and site-of-service reform.