Outpatient minimally invasive total hip arthroplasty via a modified Watson-Jones approach: technique and results

A variety of minimally invasive approaches to hip surgery in combination with multimodal anesthesia techniques and rapid rehabilitation can facilitate early discharge after total hip arthroplasty (THA). Hip replacement can be performed as outpatient surgery using the surgical technique of THA through a modified abductor-sparing Watson-Jones (anterolateral) approach, along with a comprehensive clinical pathway. One hundred thirteen sequential patients were treated with primary THA completed by noon by a single surgeon from January to August 2011. Eighty-seven of the 113 patients agreed to be placed in an outpatient protocol, and 26 were treated with an in-patient protocol. Eighty-six of the 87 patients (98.9%) in the outpatient group were successfully discharged home the day of surgery. The remaining patient was discharged home the next morning (postoperative day 1). No patients had significant medical complications, and there were no readmissions within the acute 2-week postoperative period. A deep hip infection developed in one patient at 3 weeks postoperatively. That patient was readmitted to the hospital and treated with a one-stage reimplantation procedure. This study confirmed that outpatient THA can be successfully and safely performed through a modified, minimally invasive Watson-Jones (anterolateral) approach coupled with a comprehensive clinical pathway.