Summary

TKA exchange is feasible as an out-patient procedure, by selected patients, even in cases of periprosthetic infection, without increasing the risk of complication.

Abstract

Introduction

Out-patient total knee arthroplasty (TKA) is an effective and validated procedure, even if many surgeons are afraid of an increased complication rate or delayed treatment of complications. Out-patient TKA exchange may be more challenging than primary cases, and may lead to increase the complication rate. The goal of this study was to assess the feasibility of an out-patient TKA exchange procedure in an academic setting and to control that the complication rate is not dramatically increased in comparison to in-patient TKA exchange.

Methods

A prospective, observational study was conducted. 150 consecutive TKA exchanges were included. Out-patient procedure was selected if the patient was not living alone at home, had a maximal ASA score of 2, and have his consent to this procedure. In-patient procedure was applied for other patients. All cases were operated on by two senior surgeons experienced with primary and revision TKA. Surgical and anesthetic procedures were standardized. The postoperative pain treatment algorithm was identical for all patients. All patients followed a fast-track rehabilitation process with ambulation and full weight bearing on the day of surgery and use of crutches on request. All patients were discharged home with supervised physiotherapy.
All patients were followed up to three months. Complications, rehospitalizations and reoperations were collected, and their rates were compared in the two groups by appropriate statistical tests. The severity of the complications was assessed according to the Clavien-Dindo classification and compared in the two groups by appropriate statistical test.

Results

150 case were included. There were 84 women and 66 men with a mean age of 71.4 years. The reason for TKA exchange was infection in 86 cases, aseptic loosening in 44 cases, instability in 12 cases and patella maltracking in 8 cases. 32 cases were eligible to out-patient procedure (21%) and 128 cases were operated as in-patients. No patient refused this proposal. No failure of the out-patient procedure leading to unplanned patient stay was observed. No difference was observed in the two groups when analyzing complication rate, Clavien-Dindo score, rehospitalization rate and reoperation rate. No complication related to the out-patient antibiotic treatment was observed by septic cases, and all cases were infection free after three months..

Conclusion

TKA exchange is feasible as an out-patient procedure, by selected patients, even in cases of periprosthetic infection, without increasing the risk of complication.