Abstract
Rapid recovery after total hip and knee arthroplasty, including outpatient surgery, is becoming more common and allows for earlier postoperative patient independence in activities while also reducing health care costs of inpatient hospitalization after surgery. The development and implementation of a successful and safe outpatient arthroplasty program involve a multidisciplinary approach involving surgeons, anesthesiologists, nurses, physical therapists, care coordinators, and are centered around an appropriately counseled and motivated patient. Such programs have allowed for safe outpatient total hip and total knee arthroplasty in selected patients. This chapter focuses on essential components and considerations of an outpatient arthroplasty protocol and reflects the experience of several different surgeons from major centers across the United States.
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References
Jain NB, Higgins LD, Ozumba D, et al. Trends in epidemiology of knee arthroplasty in the United States, 1990-2000. Arthritis Rheum. 2005;52(12):3928–33. https://doi.org/10.1002/art.21420.
Petersen PB, Jørgensen CC, Kehlet H, Lundbeck Foundation Center for Fast-track Hip and Knee Replacement collaborative group. Temporal trends in length of stay and readmissions after fast-track hip and knee arthroplasty. Dan Med J. 2019;66(7).
Walters M, Chambers MC, Sayeed Z, Anoushiravani AA, El-Othmani MM, Saleh KJ. Reducing length of stay in total joint arthroplasty care. Orthop Clin North Am. 2016;47(4):653–60. https://doi.org/10.1016/j.ocl.2016.05.006.
Kolisek FR, McGrath MS, Jessup NM, Monesmith EA, Mont MA. Comparison of outpatient versus inpatient total knee arthroplasty. Clin Orthop Relat Res. 2009;467(6):1438–42. https://doi.org/10.1007/s11999-009-0730-0.
Berger RA. Total hip arthroplasty using the minimally invasive two-incision approach. Clin Orthop Relat Res. 2003;417:232–41. https://doi.org/10.1097/01.blo.0000096828.67494.95.
Berger RA, Sanders S, Gerlinger T, Della Valle C, Jacobs JJ, Rosenberg AG. Outpatient total knee arthroplasty with a minimally invasive technique. J Arthroplast. 2005;20(7 Suppl 3):33–8. https://doi.org/10.1016/j.arth.2005.05.021.
Pollock M, Somerville L, Firth A, Lanting B. Outpatient total hip arthroplasty, total knee arthroplasty, and unicompartmental knee arthroplasty: a systematic review of the literature. JBJS Rev. 2016;4(12). https://doi.org/10.2106/JBJS.RVW.16.00002
Dorr LD, Thomas DJ, Zhu J, Dastane M, Chao L, Long WT. Outpatient total hip arthroplasty. J Arthroplast. 2010;25(4):501–6. https://doi.org/10.1016/j.arth.2009.06.005.
Michalesko E. #5: 2018 Annual Report. American Joint Replacement Registry. http://www.ajrr.net/media-news/press-releases/598-american-joint-replacement-registry-ajrr-releases-2018-annual-report. Accessed 20 Sept 2019.
Berger RA, Sanders SA, Thill ES, Sporer SM, Della VC. Newer anesthesia and rehabilitation protocols enable outpatient hip replacement in selected patients. Clin Orthop Relat Res. 2009;467(6):1424–30. https://doi.org/10.1007/s11999-009-0741-x.
Kelly B, Hoeffel D, Myers F. Patient reported outcomes: inpatient vs. outpatient total knee arthroplasty. Orthop Proc. 2016;98-B(SUPP_8):41. https://doi.org/10.1302/1358-992X.98BSUPP_8.ISTA2015–041.
Aynardi M, Post Z, Ong A, Orozco F, Sukin DC. Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study. HSS J. 2014;10(3):252–5. https://doi.org/10.1007/s11420-014-9401-0.
Lovald ST, Ong KL, Malkani AL, et al. Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. J Arthroplast. 2014;29(3):510–5. https://doi.org/10.1016/j.arth.2013.07.020.
Bertin KC. Minimally invasive outpatient total hip arthroplasty: a financial analysis. Clin Orthop Relat Res. 2005;435:154–63. https://doi.org/10.1097/01.blo.0000157173.22995.cf.
Shah RP, Karas V, Berger RA. Rapid discharge and outpatient total joint arthroplasty introduce a burden of care to the surgeon. J Arthroplast. 2019;34(7):1307–11. https://doi.org/10.1016/j.arth.2019.03.052.
Meneghini RM, Ziemba-Davis M, Ishmael MK, Kuzma AL, Caccavallo P. Safe selection of outpatient joint arthroplasty patients with medical risk stratification: the “outpatient arthroplasty risk assessment score”. J Arthroplast. 2017;32(8):2325–31. https://doi.org/10.1016/j.arth.2017.03.004.
Lovald ST, Ong KL, Lau EC, Joshi GP, Kurtz SM, Malkani AL. Patient selection in short stay total hip arthroplasty for medicare patients. J Arthroplast. 2015;30(12):2086–91. https://doi.org/10.1016/j.arth.2015.05.040.
Lovald S, Ong K, Lau E, Joshi G, Kurtz S, Malkani A. Patient selection in outpatient and short-stay total knee arthroplasty. J Surg Orthop Adv. 2014;23(1):2–8.
den Hartog YM, Mathijssen NMC, Vehmeijer SBW. Total hip arthroplasty in an outpatient setting in 27 selected patients. Acta Orthop. 2015;86(6):667–70. https://doi.org/10.3109/17453674.2015.1066211.
Chen D, Berger RA. Outpatient minimally invasive total hip arthroplasty via a modified Watson-Jones approach: technique and results. Instr Course Lect. 2013;62:229–36.
Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop. 2008;79(2):168–73. https://doi.org/10.1080/17453670710014941.
Ibrahim MS, Khan MA, Nizam I, Haddad FS. Peri-operative interventions producing better functional outcomes and enhanced recovery following total hip and knee arthroplasty: an evidence-based review. BMC Med. 2013;11:37. https://doi.org/10.1186/1741-7015-11-37.
Giraudet-Le Quintrec J-S, Coste J, Vastel L, et al. Positive effect of patient education for hip surgery: a randomized trial. Clin Orthop Relat Res. 2003;414:112–20. https://doi.org/10.1097/01.blo.0000079268.91782.bc.
Yoon RS, Nellans KW, Geller JA, Kim AD, Jacobs MR, Macaulay W. Patient education before hip or knee arthroplasty lowers length of stay. J Arthroplast. 2010;25(4):547–51. https://doi.org/10.1016/j.arth.2009.03.012.
Sayeed Z, Abaab L, El-Othmani M, Pallekonda V, Mihalko W, Saleh KJ. Total hip arthroplasty in the outpatient setting: what you need to know (part 1). Orthop Clin North Am. 2018;49(1):17–25. https://doi.org/10.1016/j.ocl.2017.08.004.
Memtsoudis SG, Danninger T, Rasul R, et al. Inpatient falls after total knee arthroplasty: the role of anesthesia type and peripheral nerve blocks. Anesthesiology. 2014;120(3):551–63. https://doi.org/10.1097/ALN.0000000000000120.
Krause A, Sayeed Z, El-Othmani M, Pallekonda V, Mihalko W, Saleh KJ. Outpatient total knee arthroplasty: are we there yet? (part 2). Orthop Clin North Am. 2018;49(1):7–16. https://doi.org/10.1016/j.ocl.2017.08.003.
Simons MJ, Amin NH, Cushner FD, Scuderi GR. Characterization of the neural anatomy in the hip joint to optimize periarticular regional anesthesia in total hip arthroplasty. J Surg Orthop Adv. 2015;24(4):221–4.
Elkassabany NM, Antosh S, Ahmed M, et al. The risk of falls after total knee arthroplasty with the use of a femoral nerve block versus an adductor canal block: a double-blinded randomized controlled study. Anesth Analg. 2016;122(5):1696–703. https://doi.org/10.1213/ANE.0000000000001237.
Jinadu S, Pai P, Lai Y. Ambulatory knee replacements with IPACK block. J Clin Anesth. 2020;60:55–6. https://doi.org/10.1016/j.jclinane.2019.08.021.
Wang C-J, Long F-Y, Yang L-Q, et al. Efficacy of perineural dexamethasone with ropivacaine in adductor canal block for post-operative analgesia in patients undergoing total knee arthroplasty: a randomized controlled trial. Exp Ther Med. 2017;14(4):3942–6. https://doi.org/10.3892/etm.2017.4974.
Kort NP, Bemelmans YFL, van der Kuy PHM, Jansen J, Schotanus MGM. Patient selection criteria for outpatient joint arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2017;25(9):2668–75. https://doi.org/10.1007/s00167-016-4140-z.
Berger RA, Kusuma SK, Sanders SA, Thill ES, Sporer SM. The feasibility and perioperative complications of outpatient knee arthroplasty. Clin Orthop Relat Res. 2009;467(6):1443–9. https://doi.org/10.1007/s11999-009-0736-7.
Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop. 2011;82(6):679–84. https://doi.org/10.3109/17453674.2011.636682.
Schroer WC, Diesfeld PG, LeMarr AR, Morton DJ, Reedy ME. Does extended-release liposomal bupivacaine better control pain than bupivacaine after total knee arthroplasty (TKA)? A prospective, randomized clinical trial. J Arthroplast. 2015;30(9 Suppl):64–7. https://doi.org/10.1016/j.arth.2015.01.059.
Amundson AW, Johnson RL, Abdel MP, et al. A three-arm randomized clinical trial comparing continuous femoral plus single-injection sciatic peripheral nerve blocks versus periarticular injection with ropivacaine or liposomal bupivacaine for patients undergoing Total knee arthroplasty. Anesthesiology. 2017;126(6):1139–50. https://doi.org/10.1097/ALN.0000000000001586.
Kuang M-J, Du Y, Ma J-X, He W, Fu L, Ma X-L. The efficacy of liposomal bupivacaine using periarticular injection in total knee arthroplasty: a systematic review and meta-analysis. J Arthroplast. 2017;32(4):1395–402. https://doi.org/10.1016/j.arth.2016.12.025.
DeClaire JH, Aiello PM, Warritay OK, Freeman DC. Effectiveness of bupivacaine liposome injectable suspension for postoperative pain control in total knee arthroplasty: a prospective, randomized, double blind, controlled study. J Arthroplast. 2017;32(9S):S268–71. https://doi.org/10.1016/j.arth.2017.03.062.
Premkumar A, Samady H, Slone H, Hash R, Karas S, Xerogeanes J. Liposomal bupivacaine for pain control after anterior cruciate ligament reconstruction: a prospective, double-blinded, randomized, positive-controlled trial. Am J Sports Med. 2016;44(7):1680–6. https://doi.org/10.1177/0363546516640772.
Schurman DJ, Johnson BL, Amstutz HC. Knee joint infections with Staphylococcus aureus and Micrococcus species. J Bone Joint Surg Am. 1975;57(1):40–9.
Godshaw BM, Mehl AE, Shaffer JG, Meyer MS, Thomas LC, Chimento GF. The effects of peri-operative dexamethasone on patients undergoing total hip or knee arthroplasty: is it safe for diabetics? J Arthroplast. 2019;34(4):645–9. https://doi.org/10.1016/j.arth.2018.12.014.
Rytter S, Stilling M, Munk S, Hansen TB. Methylprednisolone reduces pain and decreases knee swelling in the first 24 h after fast-track unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2017;25(1):284–90. https://doi.org/10.1007/s00167-014-3501-8.
Cheng BLY, So EHK, Hui GKM, et al. Pre-operative intravenous steroid improves pain and joint mobility after total knee arthroplasty in Chinese population: a double-blind randomized controlled trial. Eur J Orthop Surg Traumatol. 2019;29:1473–9. https://doi.org/10.1007/s00590-019-02469-5.
Liu M, Zhou R-C, Zhou X-S, et al. Effect of perioperative dexamethasone on nausea, vomiting and pain after total knee arthroplasty. Zhongguo Gu Shang. 2019;32(5):423–7. https://doi.org/10.3969/j.issn.1003-0034.2019.05.007.
Kotzé A, Carter LA, Scally AJ. Effect of a patient blood management programme on preoperative anaemia, transfusion rate, and outcome after primary hip or knee arthroplasty: a quality improvement cycle. Br J Anaesth. 2012;108(6):943–52. https://doi.org/10.1093/bja/aes135.
Rogers BA, Cowie A, Alcock C, Rosson JW. Identification and treatment of anaemia in patients awaiting hip replacement. Ann R Coll Surg Engl. 2008;90(6):504–7. https://doi.org/10.1308/003588408X301163.
Husted H, Blønd L, Sonne-Holm S, Holm G, Jacobsen TW, Gebuhr P. Tranexamic acid reduces blood loss and blood transfusions in primary total hip arthroplasty: a prospective randomized double-blind study in 40 patients. Acta Orthop Scand. 2003;74(6):665–9. https://doi.org/10.1080/00016470310018171.
Melvin JS, Stryker LS, Sierra RJ. Tranexamic acid in hip and knee arthroplasty. J Am Acad Orthop Surg. 2015;23(12):732–40. https://doi.org/10.5435/JAAOS-D-14-00223.
Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003;4:CD004423. https://doi.org/10.1002/14651858.CD004423.
Jones DL, Cauley JA, Kriska AM, et al. Physical activity and risk of revision total knee arthroplasty in individuals with knee osteoarthritis: a matched case-control study. J Rheumatol. 2004;31(7):1384–90.
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Premkumar, A., Cushner, F.D., Ast, M. (2020). Postoperative Clinical Pathways for Outpatient Arthroplasty of the Hip and Knee. In: Scuderi, G., Tria, A., Cushner, F. (eds) Rapid Recovery in Total Joint Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-030-41223-4_10
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DOI: https://doi.org/10.1007/978-3-030-41223-4_10
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