Inpatient vs Outpatient Knee Surgery for Osteoarthritis

Overseen By Jacquelyn Marsh, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: London Health Sciences Centre Research Institute and Lawson Research Institute of St. Joseph's

Disqualifiers: Cognitive issues, Lack of social support, ASA score 4

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 1 day

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether staying in the hospital overnight (Inpatient) or going home the same day (Outpatient) benefits those undergoing knee surgery for osteoarthritis. The study aims to determine which option results in higher patient satisfaction and lower costs. Participants must have knee osteoarthritis and be scheduled for a knee replacement. They should be medically stable, have a strong support system at home, and be prepared to return home after surgery. As an unphased trial, this study allows participants to contribute to important research that could enhance recovery experiences for future patients.

Do I need to stop my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What prior data suggests that these surgical methods are safe for knee osteoarthritis patients?

Research shows that outpatient knee surgery, where patients go home the same day, is generally safe. Studies have found no increase in complications after surgery, indicating that same-day discharge does not raise risks.

Additionally, outpatient procedures often result in fewer hospital visits within 90 days compared to overnight stays, demonstrating both safety and effectiveness. Another study found that home rehabilitation after outpatient knee surgery is safe and cost-effective.

Patients generally express satisfaction with outpatient knee procedures, which also tend to be less expensive. Overall, outpatient knee surgery is well-tolerated and does not appear to pose additional safety risks compared to overnight hospital stays. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it's exploring whether knee surgery for osteoarthritis can be just as effective when done outpatient, meaning patients go home the same day, compared to the traditional inpatient approach where they stay overnight. The outpatient method could offer advantages like reduced hospital costs, lower risk of hospital-acquired infections, and the comfort of recovering at home. This approach might also lead to quicker recovery times by encouraging patients to engage in physical therapy sooner in their own environment.

What evidence suggests that this trial's treatments could be effective for knee surgery in osteoarthritis?

This trial will compare inpatient and outpatient knee surgery for osteoarthritis. Studies have shown that outpatient knee surgery, where patients go home the same day, can lead to faster recovery than staying overnight in the hospital. Research indicates that these patients often recover just as well as those who remain hospitalized, requiring less pain medication and resuming daily activities sooner. Outpatient knee surgery also tends to cost less, and patients often report higher satisfaction with their experience. Additionally, the quality of recovery and long-term results are positive for those who choose outpatient care. Overall, outpatient knee surgery appears to be a safe and effective option for medically eligible patients. ^{1 2 4 6 7}

Who Is on the Research Team?

Brent Lanting, MD

Principal Investigator

London Health Sciences Centre

Are You a Good Fit for This Trial?

This trial is for adults with knee osteoarthritis who are scheduled for primary unilateral total knee replacement, can read and understand English, have a phone, plan to go home after surgery, and have someone to accompany them. It's not for those with cognitive issues or severe health problems (ASA score ≤4).

Inclusion Criteria

You have access to a home or cell phone.

I am scheduled for a first-time knee replacement on one side.

I have someone to take me home after surgery.

Exclusion Criteria

Lack of social supports at home

American Society of Anaesthesiologists (ASA) score equal to or less than 4

I understand instructions and can give informed consent.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo total knee arthroplasty with either same day discharge (outpatient) or next day discharge (inpatient)

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety, effectiveness, and patient satisfaction after treatment

1 year

Multiple visits (in-person and virtual)

What Are the Treatments Tested in This Trial?

Interventions

• Inpatient
• Outpatient

Trial Overview The study compares two approaches: standard inpatient total knee replacement requiring an overnight hospital stay versus same-day discharge outpatient surgery. It will evaluate patient satisfaction and the costs involved from various perspectives.

How Is the Trial Designed?

Group I: Outpatient Experimental Treatment 1 Intervention

Patients in the outpatient group (same day discharge following TKA) are discharged the same day following surgery. All patients are required to meet the discharge criteria to be sent home (i.e., capable of using crutches, relatively free of pain, free of nausea and vomiting, free of excess bleeding, alert and oriented, given take-home medications, and in the company of a caregiver).

Group II: Inpatient Active Control 1 Intervention

Patients in the inpatient group (following day discharge following TKA) stay in the hospital overnight and then are discharged home the next day. All patients are required to meet the discharge criteria to be sent home (i.e., capable of using crutches, relatively free of pain, free of nausea and vomiting, free of excess bleeding, alert and oriented, given take-home medications, and in the company of a caregiver).

Inpatient is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Total Knee Replacement for:

• Severe knee pain or stiffness that limits everyday activities
• Moderate or severe knee pain while resting
• Chronic knee inflammation and swelling
• Knee deformity

Approved in European Union as Total Knee Replacement for:

• Symptomatic osteoarthritis in at least 2 of the 3 compartments of the knee
• Failure of conservative treatment measures

Approved in Canada as Total Knee Replacement for:

• Severe knee pain or stiffness that limits everyday activities
• Moderate or severe knee pain while resting
• Chronic knee inflammation and swelling
• Knee deformity

Who Is Running the Clinical Trial?

London Health Sciences Centre Research Institute and Lawson Research Institute of St. Joseph's

Lead Sponsor

Trials

686

Recruited

427,000+

London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's

Lead Sponsor

Trials

678

Recruited

421,000+

London Health Sciences Centre OR Lawson Research Institute of St. Joseph's

Lead Sponsor

Trials

668

Recruited

424,000+

Lawson Health Research Institute

Lead Sponsor

Trials

684

Recruited

432,000+

Published Research Related to This Trial

A systematic review of seven studies involving 1,876 participants found that both outpatient and inpatient pathways for hip or knee arthroplasty show mixed results in terms of functional outcomes, suggesting that neither is clearly superior based solely on function.

The evidence supports the outpatient pathway as a cost-effective option for select patients, with no increase in complications, making same-day discharge a favorable choice without compromising post-operative function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of functional outcomes following inpatient versus outpatient hip or knee arthroplasty. Sattler, L., Kisaloff, L., Cragnolini, T., et al.[2022]

Outpatient total knee arthroplasty can be safely performed in selected patients, with no perioperative complications and no hospital readmissions in the outpatient cohort of 64 patients.

At a mean follow-up of 24 months, the functional outcomes (Knee Society scores) for patients discharged within 23 hours were comparable to those who stayed in the hospital for an average of 2.3 days, indicating that outpatient procedures can achieve similar effectiveness as traditional inpatient protocols.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of outpatient versus inpatient total knee arthroplasty. Kolisek, FR., McGrath, MS., Jessup, NM., et al.[2022]

In a study comparing 32 outpatients and 32 inpatients after total knee arthroplasty, there were no readmissions in either group, indicating that outpatient surgery can be safe for selected patients.

Both groups experienced similar knee mobility and low complication rates, suggesting that outpatient total knee arthroplasty is effective without increasing risks compared to inpatient procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Influence of outpatient total knee arthroplasty compared to inpatient surgery on medical and economic outcomes. Tomasi, V., Demurie, A., Ghijselings, I., et al.[2021]

Outpatient arthroplasty is shown to be safe and effective, with 94.7% of 1009 patients discharged the same day and only 1 major complication reported.

The readmission rate was low, with only 1.98% of patients requiring reoperation or emergency room visits within 90 days, suggesting that outpatient procedures can be a viable option for selected patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Shift to Same-Day Outpatient Joint Arthroplasty: A Systematic Review. Hoffmann, JD., Kusnezov, NA., Dunn, JC., et al.[2022]

Recent advancements in anesthetic techniques, particularly the use of peripheral nerve blocks like the adductor canal and IPACK blocks, have significantly reduced postoperative pain for patients undergoing total knee arthroplasty, enhancing recovery.

These innovations are facilitating the shift towards outpatient and short-stay programs for knee arthroplasty, improving patient satisfaction and reducing hospital stays.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Anesthetic and Analgesic Management for Outpatient Knee Arthroplasty. Cullom, C., Weed, JT.[2022]

Outpatient total hip and knee arthroplasty has a low 90-day readmission rate of 2.3% and a high same-day discharge rate of 93.4%, indicating that this approach can be safe and effective for selected patients.

Patients undergoing outpatient arthroplasty tend to be younger and healthier, suggesting that careful selection criteria are important for minimizing complications and ensuring successful discharges.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is Outpatient Arthroplasty Safe? A Systematic Review. Jaibaji, M., Volpin, A., Haddad, FS., et al.[2021]

Outpatient hip and knee arthroplasty has been shown to be safe and effective for select patients, with complication and readmission rates comparable to traditional inpatient procedures, potentially leading to significant cost savings.

Successful outpatient procedures rely on careful patient selection, thorough education, strong social support, and effective pain management strategies, highlighting the importance of a well-coordinated surgical team.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"Outpatient"-Same-calendar-day Discharge Hip and Knee Arthroplasty. Scully, RD., Kappa, JE., Melvin, JS.[2021]

Recent advancements in pain management and mobilization techniques have enabled patients to be discharged as early as the day after knee replacement surgery, reflecting a trend towards shorter hospital stays.

The review provides practical strategies for healthcare providers to facilitate rapid discharge after knee arthroplasty, highlighting the importance of specific care pathways and addressing patient expectations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How to Decrease Length of Hospital Stay After Total Knee Replacement. Mears, SC., Edwards, PK., Barnes, CL.[2016]

Outpatient total knee arthroplasty (TKA) is safe for selected patients, with no significant differences in 90-day emergency department visits or readmission rates compared to inpatient procedures, based on a study of 400 TKAs.

The study found that 55% of patients could potentially qualify for outpatient surgery, suggesting that expanding eligibility criteria by addressing modifiable factors could increase the number of safe outpatient procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Defining growth potential and barriers to same day discharge total knee arthroplasty. Gillis, ME., Dobransky, J., Dervin, GF.[2020]

A study comparing 43 outpatient and 43 inpatient total knee arthroplasties found that both groups reported similar quality of recovery and functional outcomes at 2 years, indicating that outpatient procedures can be as effective as inpatient ones.

Postoperative complications, including readmissions and emergency department visits within 90 days, were comparable between the two groups, suggesting that outpatient total knee arthroplasty is a safe option for selected patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Quality of Recovery, Postdischarge Hospital Utilization, and 2-Year Functional Outcomes After an Outpatient Total Knee Arthroplasty Program. Gauthier-Kwan, OY., Dobransky, JS., Dervin, GF.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10510230/

Effectiveness and safety of outpatient rehabilitation versus ... Home-based rehabilitation post-knee arthroplasty appears as an effective, safe, and cost-efficient alternative to outpatient rehabilitation.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6957327/

Management of patients undergoing same-day discharge ... Quality of recovery, postdischarge hospital utilization, and 2-year functional outcomes after an outpatient total knee arthroplasty program.

3. rushortho.com rushortho.com/media/ojfdvpb0/159191_outpatient_knee_replacement_brochure.pdf

SAME-DAY, RAPID-RECOVERY KNEE REPLACEMENT Patients who choose outpatient knee replacement typically recover more quickly than they would after inpatient surgery. It's not uncommon for ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S187812412500019X

Post-operative outcomes among knee osteoarthritis ... At 6 weeks after surgery, the majority of patients were less likely to take pain medication and resume daily living with or without assisted walking devices. In ...

5. clinicaltrials.gov clinicaltrials.gov/study/NCT04228731

Inpatient vs Outpatient Total Knee Replacement The proposed benefits of outpatient arthroplasty include similar patient outcomes with significantly lower hospital costs, and improved patient satisfaction, ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10776316/

Assessment of Patient Satisfaction and Outcomes After ... Recent studies have demonstrated that outpatient TJA procedures performed at AMCs lead to fewer 90-day readmissions as well as decreased 30-day and 90-day ...

7. mayoclinic.org mayoclinic.org/tests-procedures/hip-replacement/expert-answers/outpatient-joint-replacement/faq-20515416

Outpatient joint replacement: Is it a safe option? Joint replacement of the hip, knee, elbow and shoulder can be done safely as outpatient surgery. Most people can go home the same day as the procedure.