Total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) have always been considered inpatient surgical procedures. Questions have been asked whether, due to recent advances such as minimally invasive techniques and improved operative anaesthesia protocols, these surgeries can be successfully performed on an outpatient basis.

A study was presented to the American Academy of Orthopedic Surgery which focused on the feasibility of outpatient Total Knee Arthroplasty and unicompartmental knee arthroplasty (UKA)  surgery. It was agreed that only certain patients would be suitable for this surgery and that only those who met the criteria be considered for same-day discharge.

However, even if a patient was considered to be an ideal candidate for surgery on an outpatient basis, there is still a danger of complications which could require readmission to hospital.

What sort of criteria would a patient have to meet?

• Orthopedic assessment. This will include the physical history and the reason for the surgical intervention. Patients might have to be motivated for Total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA)  outpatient treatment, and the home situation would also need to be evaluated.
• Preoperative medical clearance. A thorough medical clearance reduces post-operative risks and visits to the ER. In addition the medical team selected has to be a team which is absolutely familiar with outpatient procedures.
• Preoperative patient education. Information about what to expect during the procedure, how to manage pain and move about after the operation helps to reduce fear and anxiety.
• The patient’s vital signs, such as blood pressure, heart rate, respiratory rate and temperature need to be stable before being considered for home discharge.

This study also demonstrates that for selected patients who meet all the criteria, outpatient Total knee arthroplasty (TKA) and UKA is safe with very few short-term complications or hospital readmissions.

Are there still concerns about outpatient TKA and UKA?

Although new protocols have been designed for outpatient knee surgery, concerns still exist for potential complications. A different study concluded that people who had outpatient surgery often returned to the ER for pain related issues, most without readmission to hospital being necessary. Unfortunately though, a small number of these cases suffered complications which required readmission to hospital.

It was also noted that patients who spent one or two nights in hospital had more or less the same readmission rates as those who had same day procedures.

No recommendations either way for outpatient TKA and UKA.

Outpatient surgery does have cost saving potential, but the possibility of readmission to hospital or the ER could quickly negate this.

There is actually no guarantee that even the most suitable of selected patients, who meet every single criteria perfectly, will have a complication-free outpatient surgical procedure.

The study included the fact that the smallest error on the part of the team performing an outpatient TKA or UKA operation could result in the patient having to spend at least one night in hospital.

At this stage it would be fair to conclude that the jury is still out concerning the feasibility and success of outpatient TKA and UKA. A big part of the decision whether to undergo the procedure depends on the eligibility of the patient, and the advice of the surgeon concerned.