Outpatient or Short Stay Total Hip or Knee Arthroplasty versus Conventional Total Hip or Knee Arthroplasty: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines [Internet]

Excerpt

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are proven procedures for treatment of advanced osteoarthritis. These procedures (THA and TKA) are also referred to as total hip replacement and total knee replacement, respectively. Traditionally these procedures were performed and managed post-operatively in an inpatient setting. Demand for these procedures continue to increase due to the aging population and greater awareness of the usefulness of these procedures. It has been reported that currently one million hip and knee arthroplasty procedures are performed annually in Canada and the USA and this is estimated to exceed four million procedures by 2030. In the light of this and considering the substantial burden on the health care system, efforts are being made to reduce length of hospital stay and minimize use of health care resources. There is growing interest in outpatient or short stay (i.e., not overnight stay, or 24 hours or less [can include a one-night stay]) THA or TKA. However there appears to be no consensus regarding the safety and efficacy of these outpatient procedures. One publication reported that some studies showed that outpatient THA or TKA have been associated with increased complications and readmissions whereas other studies have shown that, outpatient THA or TKA have been found to have outcomes comparable to inpatient THA or TKA.

The aim of this report is to summarize the evidence regarding the clinical effectiveness and cost effectiveness of outpatient or short stay THA compared with conventional (also referred to as inpatient) THA; as well as to summarize the evidence regarding the clinical effectiveness and cost effectiveness of outpatient or short stay TKA compared with conventional TKA. An additional aim is to summarize the evidence-based guidelines regarding the outpatient or short-stay THA and TKA.