Implementation of outpatient total joint arthroplasty in canada: Where we are and where we need to go

Bryn O Zomar, 1–3 Shannon L Sibbald, 1 Doug Bickford, 4 James L Howard, 2, 5 Dianne M Bryant, 1, 3 Jacquelyn D Marsh, 1, 3 Brent A Lanting 2, 3, 5 1Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; 2London Health Sciences Centre, London, ON, Canada; 3Bone and Joint Institute, University of Western Ontario, London, ON, Canada; 4Southwestern Ontario Stroke Network, London, ON, Canada; 5Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, CanadaCorrespondence: Brent A Lanting 339 Windermere Road, Rm B9-003, London, ON N6A 5A5, CanadaTel +1 519-663-3335Email brent.lanting@lhsc.on.caAbstract: Total joint arthroplasties (TJA) are successful procedures for the treatment of end-stage hip and knee arthritis. Length of stay in hospitals after these procedures has been steadily decreasing over time, with outpatient procedures (discharge on the same day as surgery) introduced in the US within the last 20 years. Reducing length of stay after TJA can provide cost savings. Centres in Canada have started to utilize outpatient TJA procedures, but we have identified some barriers that may have limited their implementation. We have summarized the current literature for outpatient TJA and discussed potential solutions for the current barriers.Keywords: total knee arthroplasty, total hip arthroplasty, outpatient, implementation, barriers