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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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
Deep venous thrombosis
Coronary artery disease
Total hip arthroplasty
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Research funding was provided by Zimmer Biomet (SOW 33).
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.
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