Outpatient THA likely safe, effective when appropriately indicated

ORLANDO, Fla. — In patients with appropriate indications, total hip arthroplasty performed in an outpatient setting is safe and effective, according to study data presented here.

Researchers culled data from an institutional registry for 549 patients who underwent a mini-posterior approach for total hip arthroplasty at a freestanding independent ambulatory surgical center between 2008 and 2014. Patients had an average age of 54.5 years and 376 patients were male. Patient desire for rapid recovery, as well as patient age and comorbidities, were noted as indications for ambulatory THA. All patients were discharged on the same day of surgery and were administered a short-acting spinal injection with lidocaine.

Average overall American Society of Anesthesiologists score was 1.6. Three patients (0.5%) were admitted for inpatient hospital stay following surgery. These patients were respectively admitted for the following: failure to disclose a long-term high-dose narcotic addiction; acetabular component migration observed on postoperative imaging; and a combination of hypotension, bradycardia and acute polyarthralgia exacerbation.

One patient was examined at a local emergency room 2 days postoperatively due to over-sedation secondary to narcotics, while 10 patients (1.8%) required hospitalization at an average of 15.7 days postoperatively for irrigation and drainage for hematoma or delayed wound healing. Of the latter, five were within the first 100 patients (5%) operated on in the series.

“Initially, we were anticoagulating the patients [with] Lovenox given the same day of surgery before they left and we think that, combined with the aggressive mobilization, led to some hematomas,” Gregg R. Klein, MD, said regarding those five patients. “This was decreased after we changed our [deep vein thrombosis] DVT protocols.”

Infections requiring surgical intervention were found in five patients (0.9%) at an average of 35 days postoperatively. Dislocated hips were found in six patients (1%) at an average of 15 days postoperatively, one of which was found to be dislocated on postoperative imaging and was immediately revised with the patient being discharged that day with no further complications. Venous thromboembolism was noted in three patients (0.5%) — one popliteal and two below-the-knee superficial vein. — by Christian Ingram

Reference:

Klein GR, et al. Paper #407. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 1-5, 2016; Orlando, Fla.

Disclosure: Klein reports he is a paid consultant and paid presenter for and receives research support from Zimmer Biomet.