Outpatient total joint arthroplasty: international evidence, rationale for implementation, and practical steps to get started

Outpatient total hip and knee arthroplasty with same day discharge is increasingly adopted as health systems seek to reduce length of stay, costs and perioperative complications while maintaining excellent patient experience. Yet implementation remains heterogeneous and many centers still lack a clear, practical roadmap. This narrative review synthe- sizes contemporary international evidence and translates it into a practical, stepwise protocol and decision algorithm for outpatient joint replacement. We summarize data from registries, randomized trials and large observational series on safety, costs and functional outcomes, and integrate this with real world experience from high volume programs. In carefully selected patients, outpatient total joint arthroplasty can provide complication, readmission and revision rates comparable to or lower than conventional inpatient care, with meaningful reductions in resource use. Successful pathways share common elements: multidisciplinary leadership, transparent selection and risk stratification, structured preoperative education and optimization, motor sparing anesthesia and multimodal analgesia, early mobilization on the day of surgery, tailored venous thromboembolism prophylaxis and a clear plan for home based rehabilitation supported by remote follow-up where available. We propose a pragmatic, algorithm based approach that helps teams start with low risk patients, monitor outcomes systematically and safely expand indications as experience, infrastructure and patient support grow.