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. 2022 Aug;18(3):338-343.
doi: 10.1177/15563316211055069. Epub 2021 Nov 8.

No Effect of Surgical Approach on Discharge Outcomes in Outpatient Total Hip Arthroplasty

Drake G LeBrun  1 , Scott M LaValva  1 , Bradford S Waddell  1 , David J Mayman  1 , Seth A Jerabek  1 , Michael M Alexiades  1 , Michael P Ast  1
Affiliations

No Effect of Surgical Approach on Discharge Outcomes in Outpatient Total Hip Arthroplasty

Drake G LeBrun et al. HSS J. 2022 Aug.

Abstract

Background: The interest in ambulatory total hip arthroplasty (THA) has increased recently due to a national focus on value-based care and improved rapid recovery protocols. Purpose: We sought to determine if surgical approach had an effect on discharge outcomes in outpatient THA. Methods: We performed a retrospective cohort study examining patients who underwent unilateral THA at a single institution using a standardized perioperative care pathway who were discharged home within 24 hours. In total, we compared 106 patients who underwent THA using the direct anterior approach (ATHA) and 90 patients who underwent THA using the posterior approach (PTHA). Univariate and multivariable analyses were used to compare time to ambulation, length of surgery, readmissions, and 90-day complications. Results:Time to ambulation in the ATHA and PTHA groups was 3.9 hours and 4.1 hours, respectively, and time to discharge was 5.9 hours and 6.0 hours, respectively. Length of surgery was shorter in the ATHA group than in the PTHA group (78 minutes vs 86 minutes, respectively). Complications occurred in 3 patients (3%) in the ATHA group vs 4 patients (4%) in PTHA group. In both groups, early ambulation (within 5 hours) predicted earlier time to discharge. Surgical approach was not associated with time to ambulation or time to discharge on multivariable analysis. Conclusion: In this retrospective study, outpatient THA was feasible in a well-selected population of patients undergoing anterior or posterior approaches. Further study is warranted.

Keywords: ambulatory arthroplasty; anterior approach; posterior approach; total hip arthroplasty.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Bradford S. Waddell, MD, and Michael P. Ast, MD, both report relationships with Surgical Care Associates, Eastern Orthopaedic Association (EOA), American Association of Hip and Knee Surgeons (AAHKS), and American Academy of Orthopaedic Surgeons (AAOS), outside the submitted work. David J. Mayman, MD, reports relationships with CyMedica Orthopedics, Evolve Ortho LLC, HS2, Imagen Technologies, InSight Medical, OrthAlign, Smith & Nephew, Stryker-Consulting, and Wishbone, outside the submitted work. Seth A. Jerabek, MD, reports relationships with Imagen and Stryker outside the submitted work. Michael M. Alexiades, MD, reports relationships with DePuy and DJO outside the submitted work. Drake G. LeBrun, MD, MPH, and Scott M. LaValva, MD, declare they have no potential conflicts of interest.

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