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Using an in-shoe plantar pressure sensor, the pressure under the first metatarsophalangeal (MTP) joint was measured in 20 asymptomatic control subjects during their normal gait. A 7-micron in-shoe pressure sensor recorded the pressure under the first MTP joint in the 20 volunteers while they were wearing their normal footwear (athletic footwear), a wooden postoperative shoe, a fiberglass short leg walking cast, and a postoperative shoe with a first MTP joint cutout orthotic device. The results showed both casting, and the postoperative shoe with the first MTP joint cutout orthotic device significantly reduced pressure under the first MTP joint compared with normal footwear, with an average decrease of 31% and 43%, respectively. However, the standard postoperative shoe did not significantly reduce first MTP pressure compared with normal footwear. Certain surgeries performed on the distal first metatarsal may benefit from a diminution of loading forces encountered during normal gait. The results of this study indicate that a reduction of first MTP pressures can best be accomplished with either a postoperative shoe with a cutout orthotic device or a short leg walking cast. A standard postoperative shoe showed inconsistent results and had no statistically significant effect on decreasing the pressure under the first MTP joint.

Recent advancements in arthroplasty surgical techniques and perioperative protocols have reduced the duration of hospitalization and length of recovery, allowing surgeons to perform joint replacement as an outpatient procedure. This study aims to evaluate the cost-effectiveness and safety of outpatient hip resurfacing. Two experienced surgeons performed 485 resurfacing surgeries. We retrospectively compared clinical outcomes and patient satisfaction with published outpatient total hip results. Furthermore, we compared average insurance reimbursement with that of local inpatient hip replacement. No major complications occurred within 6 weeks. Of the 39 patients with previous inpatient experience, 37 (95%) believed their outpatient experience was superior. The average reimbursement for hip arthroplasty at local hospitals was $50,000, while the average payment for outpatient resurfacing at our surgery center was $26,000. We conclude that outpatient hip resurfacing can be accomplished safely, with high patient satisfaction, and at a tremendous financial savings to the insurer/patient. Level of evidence III Keywords Total hip arthroplasty • Outpatient • Hip resurfacing • Minimally invasive • Hip replacement Abbreviations THA Total hip arthroplasty HRA Hip resurfacing arthroplasty Electronic supplementary material The online version of this article (