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Not so Fast! Feasibility and Safety of Outpatient Revision Total Knee Arthroplasty
Isaiah Selkridge1, Jarred Chow1, Allina Nocon1
1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
Background:
As a result of a successful transition of primary total knee arthroplasty (TKA) to an outpatient procedure, there is interest from payers to see a similar shift for revision total knee arthroplasty (rTKA) surgery. This study aimed to evaluate (1) the number of patients meeting discharge criteria within 24 hours following revision total knee arthroplasty (rTKA); (2) the proportion of patients meeting these criteria after isolated polyethylene exchange (PE) ± patellar revision compared to any other component revision; and 3) factors contributing to successful outpatient status after rTKA.
Methods:
We reviewed 3,150 rTKA procedures between 2017 and 2023. Excluding septic revisions and patients who were hospitalized > 72 hours, 1,185 were included in the final analysis. There were 357 (44%) PE ± patella revisions and 828 (56%) any other component revisions. Patients were split into: (1) those discharged within 24 hours and (2) those who stayed between 24 to 72 hours. Factors including comorbidities, procedure type, surgical time, complications, time to achieving physical therapy (PT) milestones, and estimated blood loss were compared between the two groups.
Results:
Overall, 242 of 1,185 (20.4%) patients were discharged within 24 hours following rTKA: 136 of 357 (38.1%) following polyethylene exchange versus 106 of 828 (12.8%) following any component revision (P < 0.0001). Medical complications that required intervention occurred in 107 of 357 (30%) patients undergoing poly exchange compared to 404 of 828 (48.8%) patients undergoing any component revision (P < 0.0001). Additionally, patients undergoing any component revision had greater estimated blood loss, longer surgical times, and a longer time to clearance of PT milestones. Multivariate analyses showed that PE procedure, absence of complications, and time to achieve PT milestones were predictors of discharge within 24 hours.
Conclusions:
Discharge within 24 hours following aseptic rTKA was uncommon. While outpatient revision TKA can be feasible and safe, additional studies are needed to define the appropriateness and drivers of successful discharge following revision TKA.
