Same-day discharge total hip arthroplasty through the direct anterior approach using a standardised pathway: safety...

Hip arthroplasty performed as a same-day discharge (SDD) procedure is gaining ground, but evidence in large, exclusively anterior-approach cohorts remains limited. Our hypothesis is that outpatient total hip arthroplasty (THA) via the direct anterior approach, performed in a high-volume academic centre with a standardised institutional pathway, is a safe and reproducible practice.

We conducted a retrospective single-centre study of all primary THAs performed on an outpatient basis via the direct anterior approach between January 2022 and October 2025. Epidemiological data, peri-operative parameters, and complications occurring within 60 days following surgery were recorded.

Three hundred and seventy-nine patients (384 procedures) were included. Mean age was 63.1 ± 11.6 years and mean body mass index (BMI) was 26.2 ± 4.3 kg/m². The SDD success rate was 97.7% (375/384). The most frequent causes of SDD failure were orthostatic hypotension (44.4%), uncontrolled pain (22.2%), and acute urinary retention (22.2%). The 60-day readmission rate was 1.3% (n = 5) and the emergency department visit rate was 1.8% (n = 7). Twenty-five patients (6.5%) required an early unplanned consultation. Owing to the small number of failures, subgroup comparisons between SDD success and failure were underpowered to detect differences in demographic parameters.

These results suggest that same-day discharge THA via the direct anterior approach is feasible in selected patients treated within a standardised pathway, but further prospective studies are needed to confirm generalisability.