Introduction

Outpatient total joint arthroplasty (TJA) is emerging as a viable alternative to the historically accepted hospital based inpatient TJA in the United States. Several studies have focused on the financial advantages of outpatient TJA, however little research has discussed patient reported outcome measures (PROM) and the overall patient experience. This is a retrospective comparison of PROM data in patients undergoing outpatient vs. inpatient total hip arthroplasty (THA).

Outpatient total hip arthroplasty (THA) has remained controversial and challenging. Traditional hospital stays following total joint arthroplasty were substantial and resulted in increased rates of morbidity, significant pain, and severe restriction in mobility. Advancements in the surgical approach, anesthetic regimens, and the initiation of rapid rehabilitation protocols have had an impact on the length of recovery following elective THA. Still, very few studies have specifically outlined outpatient hip arthroplasty and, thus far, none have addressed the use of robotic-arm navigation in outpatient THA. This article describes in detail the technique used to perform outpatient THA with the use of robotic-arm assistance. We believe that outpatient THA using robotic-arm assistance in combination with tissue-preserving surgery, multi-modal pain and nausea management, early rehabilitation, and stringent patient selection yields a suitable alternative to inpatient joint replacement

An outpatient total hip arthroplasty (THA) will be defined as a THA performed at an ambulatory care facility where the patient is discharged the same day as the procedure. Such procedures are being done in the United States and the hypothesis is that a “same day” THA will lead to reduced costs and improved outcomes. However, there are no appropriately powered randomised controlled trials evaluating outcomes in this group of patients to support this hypothesis. It appears that a “same day” THA is here to stay. Therefore, the selection criteria for patients that undergo the procedure needs to be carefully defined. The safety of this regimen needs to be confirmed. In an evaluation of the NSQIP database, Otero et al. compared outcomes in patients discharged on POD 0 and POD 1 and noted that THA patients in the POD 0 group had increased rates of complications. Risk factors for complications included age >70, smoking, COPD, CAD and hematocrit less than 36. In addition, the patients discharged on POD 0 had higher rates of diabetes, steroid use and lower hematocrit. Clearly, the selection criteria for this procedure needs to be defined. In two separate studies, Goyal et al. and Dorr et al. noted that approximately 25% of patients were unable to leave the hospital on POD 0 usually because of nausea and/or hypertension. Issues to consider before developing a same day discharge program include: 1) Is the patient healthy enough to go home the same day as the surgery?; 2) Does the patient live close enough to the hospital to be discharged the same day?; 3) Can the family provide the appropriate care for the patient at home?; 4) Is it really better for the patient or just better for the surgeon?. If a surgeon embarks on a same day discharge program, rigorous selection criteria must be instituted and followed. In addition, the patient must have free choice with respect to a same day discharge versus a 24-hour stay