Multi-center experience with outpatient total hip arthroplasty via a standard posterolateral approach.

BACKGROUND: This study sought to evaluate the safety, efficacy, and resource utilization of a pilot outpatient surgery program for total hip arthroplasty compared to traditional inpatient total hip arthroplasty performed via the posterolateral approach. METHODS: A cohort of 68 patients from two sites were enrolled in a regional pilot project for outpatient total hip arthroplasty (THA) and matched 1:1 against a cohort of patients undergoing routine inpatient THA. Data was extracted retrospectively from patient and hospital charts including adverse events (AE), readmission within 90 days, emergency room (ER) visits, patient calls, patient-reported outcome measures, length of stay, and multiple surgical variables. RESULTS: The outpatient group had a mean hospital stay of 13 hours, whereas the inpatient group had a mean of 58 hours (p<0.001). Three outpatients and four inpatients experienced post-op complications. Three inpatients and one outpatient visited the ER within 8 weeks of surgery. No difference in pre-operative hemoglobin (p = 0.210), or surgical blood loss (p = 0.550) was found between study groups. There was no difference found between groups regarding Oxford-12 Hip Score improvement, nor satisfaction at six months, one and two years (p>0.125). CONCLUSION: This study demonstrates that outpatient THA using the posterolateral approach is as safe and effective as inpatient THA for overall healthy and carefully screened patients, based on the low rate of AEs observed and similar patient outcomes reported. Significantly reduced time in hospital demonstrates the reduced healthcare resources associated with outpatient THA.

Midterm Results of a Contemporary, Porous-Coated Acetabular System in Patients Undergoing Primary Total Hip Replacement for Degenerative Hip Disease: A Prospective, Multicenter Study.

BACKGROUND: A contemporary, porous-coated acetabular implant designed for uncemented insertion was introduced in Europe and Australia in 2007. A similar previous acetabular system was found in several studies at 10 to 15-year follow-up to demonstrate accelerated polyethylene wear, osteolysis, and early failure. The current study was conducted to determine the midterm safety and effectiveness of this contemporary acetabular system using highly crosslinked polyethylene and ceramic liners at 5-year follow-up. METHODS: A prospective, nonrandomized study was conducted at 8 sites in Canada and the United States. All 148 study participants received a contemporary acetabular shell with proprietary porous coating. The primary outcome was the requirement for revision surgery at 5 years postoperatively. Secondary outcomes included a survival analysis, patient-reported outcome measures, radiographic failure, and postoperative adverse events. RESULTS: At 5-year follow-up there was 1 cup revised for deep infection. No cups were revised for loosening and none were found to be radiographically loose. The overall survival rate with reoperation for any reason was 97.1%. The success rate was 96.8% for polyethylene and 100% for ceramic with no difference in the success rate between either bearing surface (P = 1.0). The mean patient-reported outcome measures all improved significantly between preoperative and 5-year postoperative scores (P < .001). CONCLUSION: Results from this 5-year, multicenter, prospective study indicate excellent survivorship for this acetabular system when used with crosslinked polyethylene or ceramic bearing surfaces.