Outpatient and Early Discharge Revision Total Joint Arthroplasty: A Systematic Review and Pooled Quantitative Analysis.

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, lower mean Charlson Comorbidity Index score, and more American Society of Anesthesiologists 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 than inpatients, including periprosthetic joint infection (9.0 versus 13.0%; P < 0.001). The outpatient rTHA cohort also had a lower mean body mass index, a lower mean Charlson Comorbidity Index score, and more American Society of Anesthesiologists class 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 those in 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).

CONCLUSIONS

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.