Day-case unicompartmental knee arthroplasty: a literature review and development of a novel hospital pathway

Ann R Coll Surg Engl. 2022 Mar;104(3):165-173. doi: 10.1308/rcsann.2021.0090. Epub 2021 Jul 29.

Abstract

Introduction: We have seen unparalleled changes in our healthcare systems globally as a result of the COVID-19 pandemic. As we strive to regenerate our full capacity elective services in order to contest the increasing demand for lower limb arthroplasty, this pandemic has allowed us a rare opportunity to revise and develop novel elective arthroplasty pathways intended to improve patient care and advance healthcare efficiency. We present an extensive evidence-based review of the approaches used to achieve day-case unicompartmental arthroplasty (UKA) as well as the development of a day-case UKA care pathway in a UK NHS institution based on the evidence provided in the literature.

Methods: An extensive search of the literature was performed for articles that reported on readmission or complication rates ≥30 days postoperatively following day-case UKA.

Findings: Fifteen manuscripts reporting the results of day-case UKA, defined as discharged on the same calendar day of surgery, were included in our review. Mean reported complication rates for day-case and inpatient UKA within the follow-up periods were 4.05% and 6.52%, respectively. Mean readmission rates were 2.71% and 4.36% for day-case and inpatient UKA, respectively. The mean rate of successful same-day discharge was 92.45%.

Conclusion: We introduce our institutional Elective Day Surgery Arthroplasty Pathway (EDSAP) founded upon the evidence presented in the literature. Stringent patient selection complimented by a well-defined day-case arthroplasty pathway is fundamental for successful commencement of day-case UKA in the NHS.

Keywords: Day-case; Enhanced recovery; Outpatient; UKA; Unicompartmental knee arthroplasty.

Publication types

  • Review

MeSH terms

  • Aged
  • Ambulatory Surgical Procedures* / adverse effects
  • Ambulatory Surgical Procedures* / methods
  • Ambulatory Surgical Procedures* / statistics & numerical data
  • Arthroplasty, Replacement, Knee* / adverse effects
  • Arthroplasty, Replacement, Knee* / methods
  • Arthroplasty, Replacement, Knee* / statistics & numerical data
  • COVID-19
  • Humans
  • Middle Aged
  • Patient Discharge / statistics & numerical data
  • Patient Readmission / statistics & numerical data
  • Postoperative Complications / epidemiology