Revision Total Joint Arthroplasty at the Ambulatory Surgery Center: A Single Institutional Experience

The safety and efficacy of outpatient primary total joint arthroplasty (TJA) in appropriately selected patients have been established. As rates of revision TJA (rTJA) continue to increase, there is growing interest regarding the complications and revision incidence among procedures performed in the outpatient setting. The purpose of this study was to report outcomes of revision TJA procedures performed at an ambulatory surgery center (ASC).

A retrospective case series review of 181 patients undergoing aseptic rTJA at a free-standing ASC between January 1, 2017, and July 1, 2024, at a single large academic referral center was performed. Patients who did not have a minimum 1-year follow-up were excluded (n = 28). Our primary outcome was the incidence of complications within 90 days of rTJA, with our secondary outcome as the incidence of rerevision at final follow-up. A majority of patients underwent modular component exchanges (75.7%), with instability being the most common revision etiology (71.8%). The mean follow-up was 3.4 years (range, 1.1 to 8.6). A Kaplan-Meier survival analysis was performed to identify survivorship free of all-cause rerevision at two and five years postoperatively.

There was one patient (0.6%) who developed a deep vein thrombosis within 90 days postoperatively. There were no other medical complications seen among included patients. There were five patients (2.8%) who required reoperation in the initial 90 days due to periprosthetic joint infection (n = 3) and wound complications (n = 2). Wound complications were the most common surgical complication (n = 9.5%). A total of 20 patients (11%) experienced any complication within 90 days. Survivorship free from all-cause rerevision was 96.7% (95% confidence interval]: 92.7 to 98.5) at two years and 94.1% (95% confidence interval: 87.9 to 97.2) at five years.

Our study found that patients undergoing outpatient rTJA had a low rate of various complications in the immediate postoperative period as well as low rates of re-revision at short-term follow-up. These findings suggest that with careful patient and procedure selection, revision TJA may safely be performed at an ASC.