• Michael Mariorenzi, James Levins, Stephen Marcaccio, Alexander Orfanos, and Eric Cohen.
• Orthopaedic Surgery Resident Physician, Alpert Medical School of Brown University, Providence, RI.
• R I Med J (2013). 2020 Apr 1; 103 (3): 63-67.

IntroductionThe purpose of this review is to outline some of the major considerations when transitioning to performing total hip and knee arthroplasty in the out- patient setting. The review will discuss patient selections, peri-operative management pathways, and outcomes related to outpatient total joint arthroplasty (TJA).Patient SelectionAppropriate patient selection is key to successful outpatient TJA. Multiple indices have been proposed to estimate patient risk before undergoing outpatient TJA. Perioperative Management: In order to provide a successful outpatient TJA experience, pre-operative education class and physical therapy session can set expectations and prepare the patient for the post-operative recovery at home. Specific anesthesia techniques focus on regional blocks, multi-modal pain control, and reduction of post-operative nausea and vomiting and rapid recovery protocols have been developed to provide early mobilization and physical therapy.OutcomesNationwide analyses have found improved complication rates ranging from 1.3%-3% in outpatient TJA group compared to 3%-12% in the inpatient TJA group. Financial analyses have found significant cost savings for outpatient TJA mostly related to reduction in surgical floor care.ConclusionOutpatient TJA has the potential to improve patient experience with cost savings and no increased risk of complications in the appropriately selected patient population.

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