Outpatient Joint Replacement Can Be a Big Mistake

    Over the years, Gwo-Chin Lee, MD, from the University of Pennsylvania in Philadelphia, has softened his stance on outpatient joint replacement surgery: Once a critic of outpatient surgery, he now says the data support the safety of outpatient joint replacement in well-selected patients.

    But it’s still not something he wants to pursue in his practice.

    RELATED: Register for the 7th Annual ICJR South Hip & Knee Course

    Speaking at ICJR’s Winter Hip & Knee Course, Dr. Lee said the question is not whether outpatient joint replacement can be done; there’s nothing magical about an outpatient hip or knee arthroplasty, he said. The question for him is who benefits from outpatient surgery? And, more important, is outpatient joint replacement a risk worth taking?

    The healthcare system, payers, and owners of ambulatory surgery centers benefit economically from outpatient joint replacement, he said. But the research does not yet show a medical benefit for patients who undergo outpatient procedures.

    Dr. Lee conceded that outpatient joint replacement is here to stay: Total knee arthroplasty has already been removed from the inpatient-only list for Medicare patients by the Centers for Medicare and Medicaid Service, which is now poised to also remove total hip arthroplasty from the list. But outpatient joint replacement is not for every patient or every practice: A recently published survey showed that only 1 in 5 members of the American Association of Hip and Knee Surgeons performs outpatient total joint arthroplasty. [1]

    The bottom line: Surgeons should ask themselves, does outpatient joint surgery make sense for my patients and my practice? For Dr. Lee, the answer is no – it’s an unnecessary risk he says he is unwilling to take.

    Click the image above to watch Dr. Lee’s presentation and hear more about the research on outpatient joint replacement.


    Dr. Lee has no disclosures relevant to this presentation.


    1. Lieberman JR, Molloy RM, Springer BD. Practice management strategies among current members of the American Association of Hip and Knee Surgeons. J Arthroplasty. 2018 Jul;33(7S):S19-S22. doi: 10.1016/j.arth.2018.04.004. Epub 2018 Apr 10.


    More from the session Enhanced Recovery & Outpatient Arthroplasty at ICJR’s Winter Hip & Knee Course:

    Selecting Patients for Outpatient Surgery: A Novel Scoring System, by R. Michael Meneghini, MD

    Preoperative Medical Evaluation for Outpatient Total Joints, by David A. Kuppersmith MD

    Outpatient Total Joints: It’s an Evolution, by Ashley Dentler PT, DPT, CMLDT, CSCS

    An 18-Year Experience with Outpatient Joint Replacement, by Richard A. Berger MD