Low complication rates in outpatient total knee arthroplasty



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.


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.


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).


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


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Fig. 1



Ambulatory surgery center


Centers for Medicare and Medicaid Services


Length of stay


Total knee arthroplasty


Body mass index


Congestive heart failure


Chronic obstructive pulmonary disease


Obstructive sleep apnoea


Tranexamic acid


Emergency room


Deep venous thrombosis


Coronary artery disease


Total hip arthroplasty


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

Author information




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.

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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.

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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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  • Arthroplasty
  • Knee
  • Outpatient
  • Complications
  • Vanguard