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

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.

The safety and efficacy of unicompartmental knee arthroplasty in outpatient surgical centers: A systematic review and meta-analysis

“…8 Studies have shown that outpatient UKA is safe and feasible, does not increase the incidence of complications, and can improve patient satisfaction, surgical outcomes, and significantly save medical resources. 9 However, some scholars have expressed concerns about complications, postoperative pain, and infections in patients undergoing outpatient UKA, and studies have shown that 20% of patients undergoing outpatient UKA have extended hospital stays due to complications. 10 Currently, there is limited relevant clinical research and no published evidence from systematic reviews on the incidence of complications and revision rates of outpatient UKA, leading to ongoing debates.…”