Enabling technologies in outpatient total joint arthroplasty: an international review with application to Italian Healthcare Policy

BACKGROUND: The growing prevalence of outpatient total joint arthroplasty (TJA), driven by rising costs and declining eimbursement, has accelerated the adoption of technology-assisted solutions to enhance safety, efficiency, and cost-effectiveness. Enhanced Recovery After Surgery (ERAS) protocols have provided a strong clinical foundation, emphasizing patient education, multimodal analgesia, and early mobilization. Building upon these principles, enabling technologies – such as robotics, artificial intelligence, telemedicine, and digital engagement platforms – are being in- creasingly integrated across all perioperative phases to optimize outpatient arthroplasty outcomes. To date, limited evidence has addressed the integration of clinical, ERAS-supported perioperative practices with emerging enabling technologies in arthroplasty; the present study aims to fill this gap in knowledge by examining how these innovations can improve outcomes and cost-efficiency in outpatient joint replacement. METHODS: This study examined the available literature on enabling technologies applied to the preoperative, intraoperative, and postoperative phases of outpatient TJA. Evidence was gathered from published studies, consensus statements, and clinical registry data, including a registry from the authors’ country. Preoperatively, telemedicine and Artificial Intelligence-driven risk stratification improve patient selection and optimization, while digital nutrition and education platforms enhance readiness and compliance. RESULTS: Intraoperatively, enabling technologies increase accuracy and reproducibility without compromising surgical time once the learning curve is achieved, while simultaneously reducing length of stay, rates of complications, and rates of readmission. Postoperatively, remote monitoring, telemedicine, and telerehabilitation have proven cost-effec- tive, ensuring patients’ comfort, functional outcomes, and safe recovery. Registry data from the Autonomous Province of Bolzano showed that up to 25% of patients with low anesthetic risk and adequate home support could safely undergo outpatient arthroplasty, with potential annual national cost savings exceeding €3 million. CONCLUSIONS: Technology-enabled, ERAS-integrated outpatient arthroplasty pathways can reduce morbidity, readmissions, and healthcare costs while improving patient satisfaction and sustainability. Wider implementation requires supportive reimbursement models and further multicentric validation, particularly in healthcare systems outside the USA.