Same-Day Discharge Protocol for Total Joint Replacement

(PTClearSHoT Trial)

Recruiting at 1 trial location

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Maryland, Baltimore

Disqualifiers: Age 90+, Sleep apnea, others

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

Compensation: Varies

Number of Visits: 2

210 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new approach to allow patients to go home on the same day after total joint replacement surgery, such as hip or knee replacements. It aims to determine if patients can safely return home after receiving physical therapy training before surgery and walking with nurses afterward, rather than requiring therapy post-surgery. The trial focuses on safety issues like falls and the need for hospital readmission. It may suit those who have had hip or knee replacements, are medically stable, and have home support for a week after surgery. As an unphased trial, it offers patients the chance to contribute to innovative care practices and potentially benefit from early recovery strategies.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that this same-day discharge protocol is safe for total joint arthroplasty patients?

Research has shown that patients can safely go home on the same day as their total joint replacement. One study found no increased risk of falls, emergency room visits, or hospital readmissions for those who went home the same day. These patients practiced walking before surgery and received assistance from nurses afterward.

Another study confirmed similar results, indicating that this approach does not endanger patients. These findings suggest that same-day discharge is a safe and reliable option for individuals undergoing total joint replacement surgery. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores a novel same-day discharge protocol for total joint replacement surgery, aiming to enhance recovery and efficiency. Unlike traditional approaches that require clearance from physical therapy before discharge, this trial tests a new method where patients receive preoperative gait training and ambulate postoperatively with nursing support. This could potentially decrease hospital stay times, reduce healthcare costs, and improve patient satisfaction without compromising recovery outcomes. If successful, this method could revolutionize postoperative care for joint replacement patients.

What evidence suggests that this protocol is effective for same-day discharge after total joint replacement?

Research has shown that the new same-day discharge plan for joint replacement surgery, tested in this trial, is both effective and safe. Participants may receive this novel protocol, which studies have demonstrated increases the number of patients who can go home the same day without raising the risk of falls, emergency room visits, or hospital readmissions. One study found that the success rate of same-day discharge increased from 8% to 20%, while the rate of hospital readmissions dropped to 4-7%. Additionally, another review found no negative effects on patient health when more patients were discharged the same day. This method allows more patients to leave the hospital sooner, saving hospital resources and reducing costs. ^{1 2 5 6 7}

Are You a Good Fit for This Trial?

This trial is for adults over 18 who are having a total hip or knee replacement and can go home the same day. They need someone to stay with them at home for a week after surgery and must be medically okay to leave the hospital after waking up from anesthesia.

Inclusion Criteria

I am scheduled for my first hip or knee replacement surgery.

I can go home the same day as my surgery and have someone to stay with me for a week.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Preoperative Physical Therapy

Participants receive gait and stair training from physical therapy prior to total joint arthroplasty

1 day

1 visit (in-person)

Postoperative Ambulation

Participants ambulate with post-anesthesia care unit (PACU) nurses trained by PT on postoperative mobilization before home discharge

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessment of postoperative falls, ER visits, and readmissions

90 days

What Are the Treatments Tested in This Trial?

Interventions

• Conventional postoperative physical therapy clearance
• Novel same-day discharge protocol after total joint arthroplasty

Trial Overview The study tests if patients can safely skip post-surgery physical therapy before going home on the same day of joint replacement surgery. Instead, they get walking training before surgery and help from nurses trained in moving patients right after.

How Is the Trial Designed?

Group I: Preoperative Physical Therapy, Postoperative Ambulation with Nursing Experimental Treatment 1 Intervention

Patients will receive gait/stair training from physical therapy prior to total joint arthroplasty, then ambulate with nursing postoperatively prior to home discharge

Group II: Conventional Postoperative Physical Therapy Clearance Active Control 1 Intervention

Patients will be evaluated and cleared by physical therapy after total joint replacement surgery prior to home discharge

Who Is Running the Clinical Trial?

University of Maryland, Baltimore

Lead Sponsor

Trials

729

Recruited

540,000+

Rothman Institute Orthopaedics

Collaborator

Trials

127

Recruited

22,600+

Published Research Related to This Trial

In a study of 1778 patients who underwent same-day discharge (SDD) total joint arthroplasty (TJA), those enrolled in a formal SDD program had shorter surgical times compared to those who were SDD but not enrolled (87.29 vs 109.39 minutes).

Despite the differences in surgical times, both groups showed no significant differences in discharge outcomes, emergency department visits, readmissions, or joint function scores, suggesting that formal enrollment in an SDD program may not be necessary for achieving successful outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Formal Same-Day Discharge Total Joint Arthroplasty Program May Not Be Necessary: A Propensity-Matched Cohort Study. Singh, V., Realyvasquez, J., Simcox, T., et al.[2022]

A systematic review of 14 studies involving 222,766 cases found that same-day discharge total joint arthroplasty (TJA) has a satisfactory safety profile, with no significant differences in mortality or readmission rates compared to inpatient TJA.

However, same-day discharge TJA showed a significantly higher rate of overall complications compared to fast-track inpatient TJA, indicating that while it is generally safe, careful monitoring for complications is essential.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Same-day discharge arthroplasty has a higher overall complications rate than fast-track arthroplasty: a systematic review and meta-analysis. Li, M., Luo, R., Zeng, Y., et al.[2022]

A study of 1200 patients undergoing same-day discharge total joint arthroplasty (SDD-TJA) showed that this procedure can be safely performed in community hospitals, with a low 30-day complication rate of only 1.3% for readmissions.

However, the use of general anesthesia was linked to a higher risk of 'failure to launch' (FTL), occurring in 7.1% of patients, suggesting that spinal anesthesia is a safer option for minimizing complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes of a Total Joint Arthroplasty Enhanced Recovery Program in a Community Hospital Setting. Adams, CT., O'Connor, CM., Young, JR., et al.[2021]

Same-day-discharge total joint arthroplasty is safe and does not lead to higher readmission rates in carefully selected patients, thanks to improvements in anesthesia, surgical techniques, and care protocols.

This approach is also cost-effective and is expected to become more common as healthcare focuses on value-driven care, highlighting the importance of a team-based strategy for successful outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Team Approach: Same-Day Discharge of Patients Undergoing Total Joint Arthroplasty. Crawford, AM., Chen, AF., Sabeti, A., et al.[2021]

Same day discharge after total joint arthroplasty is becoming a viable option for selected patients, potentially reducing hospital stays and associated costs.

The review discusses institutional guidelines for patient selection and contraindications, emphasizing the importance of careful evaluation to ensure safety and minimize complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Same Day Discharge After Total Joint Arthroplasty The Future May Be Now. Aggarwal, V., Thakkar, S., Collins, K., et al.[2018]

In a study of 5,250 hip and 9,752 knee arthroplasty patients with higher comorbidities, same-day discharge was found to be as safe as inpatient care, showing no increased risk of emergency department visits, readmissions, or complications.

Same-day discharge for knee arthroplasty also demonstrated noninferiority in terms of mortality risk, suggesting that this approach can be safely expanded to higher-risk patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association Between Same-Day Discharge Total Joint Arthroplasty and Risk of 90-Day Adverse Events in Patients with ASA Classification of ≥3. Reddy, NC., Prentice, HA., Paxton, EW., et al.[2023]

In a study of 1491 patients undergoing same-day discharge (SDD) total joint arthroplasty, 93% were successfully discharged on the same day, while 7% required a longer hospital stay, often due to factors like being non-married or having higher ASA class (III).

Patients who failed to be discharged the same day (FTL) did not experience worse outcomes compared to those who were successfully discharged, as both groups had similar rates of readmissions, revisions, and patient-reported outcomes, indicating that FTL does not predict adverse results.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Failure to Meet Same-Day Discharge is Not a Predictor of Adverse Outcomes. Singh, V., Nduaguba, AM., Macaulay, W., et al.[2022]

From 2011 to 2016, the rate of same-day discharge (SDD) following total joint arthroplasty (TJA) increased significantly from 0.95% to 20.5%, but about 68% of patients were still discharged directly home, indicating a stable trend in discharge practices.

Patients discharged to alternate care facilities were older, had higher comorbidity scores, and experienced more complications compared to those discharged directly home, highlighting the need for careful consideration of patient disposition in SDD TJA studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Same-Day Discharge Following Total Joint Arthroplasty: Examining Trends, Discharge Dispositions, and Complications Over Time. Clouette, J., Agarwalla, A., Ravi, B., et al.[2020]

In a study of 1100 consecutive primary total joint arthroplasties (TJAs), 75% of unselected patients achieved same-day discharge (SDD) to home, demonstrating that ambulatory surgery is feasible and safe for most patients without increasing complication risks.

Factors such as being female and undergoing total hip arthroplasty (THA) were associated with a higher likelihood of failing to achieve SDD, indicating that patient characteristics can influence discharge outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Same-day discharge to home is feasible and safe in up to 75% of unselected total hip and knee arthroplasty. Verdier, N., Boutaud, B., Ragot, P., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11962803/

Same-day discharge pathway for elective total hip and ... The results of the SDD rate increased from 8% to 20% with a success rate of 82% SDD, while achieving a decrease in readmission rates to 4–7% ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0883540325005315

Evaluating the Safety and Efficacy of Same Calendar Day ... Retrospective review of all patients undergoing primary TJA over a three-year period (January 1, 2020, to December 31, 2022) was performed.

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9905097/

An Increase in Same-day Discharge After Total Joint ... An Increase in Same-day Discharge After Total Joint Arthroplasty During the COVID-19 Pandemic Does Not Influence Patient Outcomes: A Retrospective Cohort ...

4. aoao.org aoao.org/2025/07/30/same-day-arthroplasty-in-the-community-setting-an-institutional-experience-examining-factors-for-successful-discharge/

Same Day Arthroplasty in the Community Setting Patients were given the same-day discharge designation based on a pre-established institutional protocol. The primary outcome was the successful ...

5. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0883540323006599

Success of Same-Day Discharge Total Hip and Knee ... The aim of this study was to compare the success rate of SCDD in an ambulatory surgical center (ASC) versus hospital setting.

6. bmjopenquality.bmj.com bmjopenquality.bmj.com/content/14/1/e003170

Same-day discharge pathway for elective total hip and ... The aim was to increase the same-day discharge (SDD) rate for THA and TKA from 8% to 15% within a 12-month period.

7. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40441320/

Formal Physical Therapy Clearance Is Not Necessary for ... Conclusions: Our novel primary TJA discharge protocol without postoperative PT clearance maximizes safe day-of-surgery discharge while maintaining patient ...