Not so Fast! Feasibility and Safety of Outpatient Revision Total Hip Arthroplasty.

Background: As total hip arthroplasty (THA) transitions to the outpatient setting, so will some revision procedures. However, revisions are more complex and have greater impact physiologic stress on the patient. Therefore, the purposes of this study were to: (1) evaluate the number of patients discharged within 24 hours following revision; (2) compare the proportion of patients discharged following ball/liner exchange versus any component revision; and (3) determine the factors leading to successful discharge within 24 hours following revision THA (rTHA).

Methods: There were 2,446 rTHA surgeries between 2017 and 2023 reviewed, of which 944 (38.6%) were included in the final analysis. There were 415 (44%) ball/liner exchanges and 529 (56%) component revisions. Septic revisions and patients who stayed in the hospital for > 72 hours were excluded. Patients were split into two cohorts: (1) those discharged within 24 hours; and (2) those who stayed in the hospital between 24 to 72 hours. Basic demographics and multiple perioperative factors were compared between cohorts.

Results: There were 192 (20%) patients discharged within 24 hours following the rTHA, 126 (30.4%) following ball/liner exchange versus 66 (12.5%) following any component revision (P < 0.001). Medical complications that required intervention occurred in 179 (34%) patients undergoing ball/liner exchange compared to 270 (65%) patients undergoing any component revision (P < 0.01). There were no significant differences in patient comorbidities between cohorts, but patients undergoing any component revision were older, had greater estimated blood loss, more complications, and a longer time to physical therapy clearance, which was 29.6 hours in the ball/liner cohort compared to 39.1 hours in any component revision cohort (P < 0.0001).

Conclusions: Despite modern enhanced recovery protocols, discharge within 24 hours following aseptic rTHA remains uncommon. Medical complications requiring active management occurred in nearly 50% of patients. The strongest predictors of same-day discharge were time to achieving physical therapy milestones and the absence of perioperative complications.