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Routine Laboratory Tests are not Necessary After Primary Total Joint Arthroplasty: A Prospective Study Utilizing a

Jessica L H Phillips¹, Yale A Fillingham¹, William F Mitchell²

¹Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA; Rothman Institute, Philadelphia, PA.

The Journal of Arthroplasty

|April 11, 2022

Summary

This summary is machine-generated.

Discontinuing routine laboratory tests after total joint arthroplasty (TJA) is safe and effective. This approach did not increase 90-day complications in TJA patients, supporting its implementation.

Keywords:

complications laboratory tests outcome outpatient total joint arthroplasty total joint arthroplasty

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Area of Science:

Orthopedic Surgery
Clinical Medicine
Patient Safety

Background:

Routine laboratory testing post-total joint arthroplasty (TJA) lacks evidence-based support.
Previous studies have not prospectively evaluated the impact of discontinuing these tests.
This research addresses the need for evidence on optimizing TJA care pathways.

Purpose of the Study:

To determine if discontinuing routine laboratory tests after TJA affects 90-day complication rates.
To evaluate the safety and efficacy of a selective laboratory testing protocol in TJA patients.
To provide evidence for a revised clinical guideline for post-TJA laboratory monitoring.

Main Methods:

Prospective protocol change study at a high-volume orthopedic center.
Comparison of routine laboratory testing (control) versus algorithmic selective testing (protocol) groups.
Exclusion criteria applied for patients with significant comorbidities; 90-day outcomes analyzed.

Main Results:

No significant difference in 90-day complications between the protocol (937 patients) and control (891 patients) groups.
Similar rates of transfusions, electrolyte corrections, and length of stay between groups.
The protocol group showed more fluid boluses and home discharges, indicating no adverse impact.

Conclusions:

Discontinuing routine laboratory tests following TJA is safe and effective when using an algorithmic approach.
The revised protocol can be safely implemented for the majority of primary unilateral TJA patients.
This strategy optimizes resource utilization without compromising patient safety or outcomes.