Skip to main content
Log in

Outpatient Total Joint Arthroplasty

  • Quality and Cost Control in TJA (B Waddell, section editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. With current pressures on arthroplasty surgeons and their associated institutions to reduce costs per episode of care, it is important to define the steps and challenges associated with establishing an outpatient arthroplasty program.

Recent Findings

Several studies have outlined techniques of selecting patients suitable for this type of postoperative pathway. With emerging concerns about patients who undergo outpatient arthroplasty being at increased risk of medical complications, which may lessen projected cost savings, it is important to identify value-based strategies to optimize patient recovery after OTJA.

Summary

This article reviews digital techniques for patient selection and data collection, operating room efficiency systems, and provides a summary of methods to build and maintain value in outpatient total joint replacement within the framework of bundled payment reimbursement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kehlet H, Søballe K. Fast-track hip and knee replacement — what are the issues? Acta Orthop. 2010;81(3):271–2.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Impact of Change® v16.0; HCUP National Inpatient Sample (NIS). Healthcare cost and utilization project (HCUP). 2013. Agency for Healthcare Research and Quality, Rockville, MD; OptumInsight, 2014; The following 2014 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; The Nielsen Company, LLC, 2016; Sg2 Analysis, 2016.

  3. Courtney P, Boniello A, Berger R. Complications following outpatient total joint arthroplasty: an analysis of a national database. J Arthroplast. 2017;32:1426–30.

    Article  Google Scholar 

  4. Iorio R. Strategies and tactics for successful implementation of bundled payments: bundled payment for care improvement at a large, urban, Academic Medical Center. J Arthroplast. 2015;30(3):349–50.

    Article  Google Scholar 

  5. Ellimoottil C, Ryan A, Hou H, Dupree J, Hallstrom B, Miller D. The new bundled payment program for joint replacement may unfairly penalize hospitals that treat patients with medical comorbidities. Health Aff (Millwood). 2016;35(9):1651–7.

    Article  Google Scholar 

  6. Caffrey M. The future of the comprehensive care for joint replacement program. Am J Manag Care. 2017.

  7. Gollogly S Safety and efficacy of outpatient arthroplasty. Advisory panel on outpatient payments. Center for Medicare and Medicaid services report. Woodlawn, Maryland, August 22, 2016.

  8. Sibia US, King PJ, MacDonald JH. Who is not a candidate for a 1-day hospital-based total knee arthroplasty. J Arthroplast. 2017;32(1):16–9.

    Article  Google Scholar 

  9. Berger RA, Cross MB, Sanders S. Outpatient hip and knee replacement: the experience from the first 15 years. Instr Course Lect. 2016;65:547–51.

    PubMed  Google Scholar 

  10. Tristaino V, Lantieri F, Tornago S, Gramazio M, Carriere E, Camera A. Effectiveness of psychological support in patients undergoing primary total hip or knee arthroplasty: a controlled cohort study. J Orthop Traumatol. 2016;17(2):137–47.

    Article  CAS  PubMed  Google Scholar 

  11. Argenson J-NA, Husted H, Lombardi A, Booth RE, Thienpont E. Global forum: an international perspective on outpatient surgical procedures for adult hip and knee reconstruction. J Bone Joint Surg. 2016;98(13):e55.

    Article  PubMed  Google Scholar 

  12. Reinke C, Kelz R, Zubizarreta J, Lanyu M, Saynisch P, Kyle F, et al. Obesity and readmission in elderly surgical patients. Surgery. 2012;152(3):355–62.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Courtney PM, Rozell JC, Melnic CM, Lee G-C. Who should not undergo short stay hip and knee arthroplasty? Risk factors associated with major medical complications following primary total joint arthroplasty. J Arthroplast. 2015;30(9):1–4.

    Article  Google Scholar 

  15. Hensell MG, Pins J. Virtual BackTable. Reducing cost of on-boarding. AORN Annual Meeting. Denver, Colorado, March 7–11, 2015.

  16. Berend ME, Berend KR, Lombardi AV. Advances in pain management. Bone Joint J. 2014;96(11):7–9.

    Article  PubMed  Google Scholar 

  17. Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Journal. 2011;93(11):1075–84.

    Google Scholar 

  18. Lombardi A, Barrington JW, Berend KR, Berend ME, Dorr LD, Hamilton W, et al. Outpatient arthroplasty is here now. Instr Course Lect. 2016;65:531–46.

    PubMed  Google Scholar 

  19. Liu D, Dan M, Martinez Martos S, Beller E. Blood management strategies in total knee arthroplasty. Knee Surg Rel Res. 2016;26(3):179–87.

    Article  Google Scholar 

  20. Aglietti P, Baldini A, Vena LM, et al. Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop Rel Res. 2000;371:169–77.

    Article  Google Scholar 

  21. Sculco TP, Baldini A, Keating EM. Blood management in total joint arthroplasty. Instr Course Lec. 2005;54:51–66.

    Google Scholar 

  22. Hooper J, Schwarzkopf R. Additional tools to prevent blood loss in total joint arthroplasty. Tech Orthop. 2017;32(1):34–40.

    Article  Google Scholar 

  23. Wind TC, Barfield WR, Moskal JT. The effect of tranexamic acid on transfusion rate in primary total hip arthroplasty. J Arthroplast. 2014;29(2):387–9.

    Article  Google Scholar 

  24. Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty. J Bone Joint Surg. 2012;94(13):1153–9.

    Article  PubMed  Google Scholar 

  25. Winther SB, Foss OA, Wik TS, Davis SP, Engdal M, Jessen V, et al. 1-year follow-up of 920 hip and knee arthroplasty patients after implementing fast-track: good outcomes in a Norwegian university hospital. Acta Orthop. 2015;86(1):78–85.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bovonratwet P, Ondeck NT, Tyagi V, Nelson SJ, Rubin LE, Grauer JN. Outpatient and inpatient unicompartmental knee arthroplasty procedures have similar short-term complication profiles. J Arthroplast. 2017;S0883-5403(17):30443–6.

    Google Scholar 

  27. Dorr LD, Thomas DJ, Zhu J, Dastane M, Chao L, Long WT. Outpatient total hip arthroplasty. J Arthroplast. 2010;25(4):501–6.

    Article  Google Scholar 

  28. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Huang A, Ryu J-J, Dervin G. Cost savings of outpatient versus standard inpatient total knee arthroplasty. Can J Surg. 2017;60(1):57.

    PubMed  PubMed Central  Google Scholar 

  30. Hoorntje A, Koenraadt KLM, Boevé MG, van Geenen RCI. Outpatient unicompartmental knee arthroplasty: who is afraid of outpatient surgery. Knee Surg Sports Tramatol Arthrosc. 2017;25(3):759–66.

    Article  Google Scholar 

  31. Lovecchio, et al. Is outpatient arthroplasty as safe as fast-track inpatient arthroplasty? A propensity score matched analysis. J Arthroplast. 2016;31:197–201.

    Article  Google Scholar 

  32. Kaplan RS, Porter ME. How to solve the cost crisis in health care. Harv Bus Rev. 2011;89(9):46–52.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Jack M. Bert or Sam Moen.

Ethics declarations

Conflict of Interest

All authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Quality and Cost Control in TJA

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bert, J.M., Hooper, J. & Moen, S. Outpatient Total Joint Arthroplasty. Curr Rev Musculoskelet Med 10, 567–574 (2017). https://doi.org/10.1007/s12178-017-9451-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-017-9451-2

Keywords

Navigation