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Low complication rates in outpatient total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The primary purpose of this study is to report the incidence of complications associated with outpatient total knee arthroplasty (TKA). Secondarily, 2-year minimum outcomes are reported.

Methods

Between 2013 and 2016, 928 patients underwent 1143 outpatient TKAs with the Vanguard Complete Knee System (Zimmer Biomet, Warsaw, IN). Patients were selected for outpatient surgery if they were medically optimized without a failing organ system and had sufficient support at home. Overnight stays, medical complications and early perioperative complications were assessed in this entire cohort. Two-year minimum follow-up was available on 793 patients (978 knees). Patient records were analyzed for outcome measures and revisions.

Results

In 124 procedures, the patient stayed overnight for 23-h observation. Thirty-seven (3.2%) were for convenience reasons and 87 (7.6%) for medical observation. Heart disease and chronic obstructive pulmonary disease were associated with increased risk of overnight stay. Excluding manipulations, reoperation within 90 days occurred in eight (0.7%) knees. Patients with 2-year minimum follow-up had significant improvements in ROM, Knee Society Clinical, Functional and Pain scores (p < 0.005). Nine (0.8%) patients required revision. Manipulations were performed on 118 (10.3%) patients. The overall deep infection rate was 0.17% (2/1143).

Conclusions

Outpatient TKA is safe for a large proportion of patients. Certain medical co-morbidities increase the risk of overnight stay. Patients had significant improvement in ROM and outcome scores with low revision rate.

Level of evidence

III.

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Abbreviations

ASC:

Ambulatory surgery center

CMS:

Centers for Medicare and Medicaid Services

LOS:

Length of stay

TKA:

Total knee arthroplasty

BMI:

Body mass index

CHF:

Congestive heart failure

COPD:

Chronic obstructive pulmonary disease

OSA:

Obstructive sleep apnoea

TXA:

Tranexamic acid

ER:

Emergency room

DVT:

Deep venous thrombosis

CAD:

Coronary artery disease

THA:

Total hip arthroplasty

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Funding

Research funding was provided by Zimmer Biomet (SOW 33).

Author information

Authors and Affiliations

  1. Joint Implant Surgeons, Inc., 7277 Smith’s Mill Road, Suite 200, New Albany, OH, 43054, USA

    David A. Crawford, Joanne B. Adams, Keith R. Berend & Adolph V. Lombardi Jr.

  2. Mount Carmel Health System, 7333 Smith’s Mill Road, New Albany, OH, 43054, USA

    Keith R. Berend & Adolph V. Lombardi Jr.

  3. Department of Orthopaedics, The Ohio State University Wexner Medical Center, 376W 10th Ave, Suite 725, Columbus, OH, 43210, USA

    Adolph V. Lombardi Jr.

Authors
  1. David A. Crawford
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  2. Joanne B. Adams
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  3. Keith R. Berend
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  4. Adolph V. Lombardi Jr.
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Contributions

DC reviewed and synthesized all the data, performed the literature review and assisted in writing the manuscript. KB and AL performed surgery on all study subjects and assisted in writing/editing the manuscript. JA compiled all research data, performed statistical analysis and assisted in writing/editing the manuscript.

Corresponding author

Correspondence to David A. Crawford.

Ethics declarations

Conflict of interest

Institutional research funding in direct support of this and other studies was received from Zimmer Biomet. The authors KB and AL are consultants to and receive royalties from Zimmer Biomet, receive royalties from Innomed, and have minority investment interests in SPR Therapeutics, Joint Development Corporation, Elute Inc., and VuMedi. An institution of the authors, Joint Implant Surgeons, Inc., receives research funding from SPR Therapeutics and Kinetic Concepts Inc.

Ethical approval

All patients signed a general research consent, approved and monitored by an independent institutional review board (Western IRB, Puyallup, Washington, protocol #2004-03), which allows inclusion in retrospective reviews.

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Crawford, D.A., Adams, J.B., Berend, K.R. et al. Low complication rates in outpatient total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 28, 1458–1464 (2020). https://doi.org/10.1007/s00167-019-05538-8

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