The successful migration of total joint arthroplasty from the hospital inpatient to outpatient ASC setting.

BACKGROUND: This study was undertaken to analyze the clinical results and complication rate of patients undergoing outpatient total joint arthroplasty by a single orthopedic group. All surgeries were performed in the practice-owned ambulatory surgery center (ASC). METHODS: All patients indicated for outpatient total joint arthroplasty from 2016-2019 with complete pre and post-operative patient reported outcomes were enrolled in the study including hip, knee and partial knee replacements. Patient reported outcomes including HOOS, KOOS and VR-12 were collected at six months. Patient complication and satisfaction data was also collected. RESULTS: There were 1007 patients enrolled in the study. At six months, THA HOOS and VR-12 scores improved to 82.2 and 54.5/45. TKA KOOS and VR-12 scores improved to an average of 74.3 and 54.0/43.6. At six months, UKA scores improved to an average of 73.6 and 55.1/41.2. All HOOS, KOOS and VR-12 PCS scores improvements were statistically significant (p < 0.001) and met MCID thresholds. A separate cohort of 1898 regionally tracked cases with comprehensive global complication data exhibited 111 complications (unplanned post-operative events generating a medical expense) including manipulation 13 (0.68%), DVT/PE 4 (0.2%), medical 45 (2.4%), wound 8 (0.4%), infection 8 (0.4%). Sixty-six outpatient cases (3.5%) experienced clinical complications requiring some form of additional treatment. CONCLUSION: Outpatient joint arthroplasty performed in the ASC is safe and effective in appropriately selected patients with complication rates that compares favorably to inpatient procedures.

Unicompartmental Knee Arthroplasty Is Not Associated With Increased Revision Rates in Obese Patients.

BACKGROUND: There is controversy among arthroplasty surgeons in regard to performing unicompartmental knee arthroplasty (UKA) in obese patients based on current literature. The aim of this study is to investigate whether UKA is associated with increased complications and revision rates in obese (body mass index [BMI] > 30 kg/m2), morbidly obese (BMI > 40 kg/m2), and super morbid obese (BMI > 50 kg/m2) patients. METHODS: We retrospectively reviewed all UKAs performed at our institution from January 2008 to December 2017. A total of 2178 UKA procedures were performed during this period. The patients were categorized based on BMI to include normal weight (BMI = 20-30 kg/m2), obese (BMI ≥ 30.1-40 kg/m2), morbidly obese (BMI ≥ 40.1-50 kg/m2), and super morbid obese (BMI ≥ 50.1 kg/m2) groups. Record review was performed to obtain demographic data, need for revision (timing, type, and etiology), and complication rate and cause. RESULTS: The 2178 UKA cases were eligible for inclusion in this investigation. We performed 2028 medial UKAs and 150 lateral UKAs. The mean clinical follow-up period was 3.7 years, and the mean time from index surgery to revision was 7.2 years. Of the 2178 UKA cases, 1167 had a 3-year minimum follow-up. The overall revision rate in all patients was 2.2%. There was no significant difference (P > .05) in revision rates among normal weight (3.0%), obese (2.7%), morbidly obese (1.9%), and super morbid obese patients (1.8%). Most failures in all groups were secondary to progression of osteoarthritis requiring total knee arthroplasty. CONCLUSIONS: Similar rates of revision were found for UKAs performed on obese, morbidly obese, or super morbid obese patients (≤2.0% revision rate) vs normal BMI (2.7% revision rate) patients. Progressive osteoarthritis was the most common mechanism of UKA failure. Obesity is not a contraindication for UKA despite previous recommendations to the contrary.