Current Trends and Future Directions for Outpatient Total Joint Arthroplasty: A Review of the Anesthesia Choices and Analgesic Options

Abstract

The aging population and the obesity epidemic have led to an increased rate of joint arthroplasty procedures, specifically total knee arthroplasty and total hip arthroplasty. These surgeries are associated with increased hospital length of stay and, consequently, higher costs. Despite the benefits of outpatient surgery, only a small percentage of total joint arthroplasties (TJAs) are done in this manner. We reviewed the most up-to-date trends for outpatient TJA and discussed essential factors for a successful outpatient program, including the proper patient selection process and best available anesthetic and analgesic options, along with their risks and benefits. Risk stratification tools, such as the Outpatient Arthroplasty Risk Assessment, are helpful for predicting outcomes regarding outpatient TJA, and neuraxial anesthesia should be considered to minimize complications and facilitate early discharge. A multimodal analgesia regimen could be effective for pain management in outpatient TJA, and the currently recommended peripheral nerve blocks for total hip arthroplasty and total knee arthroplasty are the fascia iliaca compartment block and adductor canal block, respectively. However, blocks should be carefully considered for outpatient procedures. Enhanced recovery after surgery (ERAS) protocols help to guide perioperative care teams and allow for improved patient recovery, decreased length of stay, and increased patient satisfaction.

Peripheral Nerve Blocks in Geriatric Orthopedic Anesthesia for Hip Fractures: Unveiling Economic and Clinical Dimensions

“…Total joint arthroplasty's high-cost burdened Medicare in 2013, exceeding $33,000 per surgery and totaling $6.5 billion. Longer hospital stays further inflate costs, highlighting the need for cost-containment strategies [16]. Hospital et al'study considered $3,500 as the median price for the analysis.…”

“…Research by Chowdary et al suggests that spinal anesthesia, especially in elderly hip hemiarthroplasty patients, is associated with reduced complications, shorter surgery times, and overall mortality [15]. Further evidence supports the advantages of spinal anesthesia, such as decreased pneumonia, infections, critical care utilization, and falls, making it a recommended choice for total hip and knee replacements [16] [17].…”