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Outpatient or Short Stay Total Hip or Knee Arthroplasty versus Conventional Total Hip or Knee Arthroplasty: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines

Last updated: November 6, 2020
Project Number: RC1313-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of outpatient or short stay total hip arthroplasty compared with conventional total hip arthroplasty?
  2. What is the clinical effectiveness of outpatient or short stay total knee arthroplasty compared with conventional total knee arthroplasty?
  3. What is the cost effectiveness of outpatient or short stay total hip arthroplasty compared with conventional total hip arthroplasty?
  4. What is the cost effectiveness of outpatient or short stay total knee arthroplasty compared with conventional total knee arthroplasty?
  5. What are the evidence-based guidelines regarding outpatient or short-stay total hip arthroplasty and total knee arthroplasty?

Key Message

Three relevant systematic reviews and one relevant economic evaluation were identified.

Generally, rates of complication, readmission, and reoperation were not statistically different or appeared numerically comparable between the outpatient and inpatient total hip arthroplasty (THA) groups. Mortality rates were low and appeared to be numerically comparable between the outpatient and inpatient THA groups.

Generally, rates of complication, readmission, and reoperation were not statistically different or appeared numerically comparable between the outpatient and inpatient total knee arthroplasty (TKA) groups. There were inconsistencies with respect to mortality rates in the outpatient and inpatient TKA groups; this finding was based on two studies included in one systematic review.

Inpatient THA was considered not to be cost-effective compared to outpatient THA at a willingness to pay threshold of US$50,000 as the incremental cost effectiveness ratio (ICER) for inpatient THA was US$81,116 per quality adjusted life year (QALY) for Medicare and US$140,917 per QALY for private payer insurance.

Findings need to be interpreted in the light of limitations such as evidence of limited quantity and low quality; and lack of long-term data.

No evidence was identified regarding the cost effectiveness of outpatient or short stay TKA.

No evidence-based guidelines regarding the outpatient or short stay THA or TKA were identified.