title: The constraints on day-case total knee arthroplasty: the fastest fast track.
abstract: Total knee arthroplasty (TKA) is a major orthopaedic intervention. The length of a patient's stay has been progressively reduced with the introduction of enhanced recovery protocols: day-case surgery has become the ultimate challenge. This narrative review shows the potential limitations of day-case TKA. These constraints may be social, linked to patient's comorbidities, or due to surgery-related adverse events (e.g. pain, post-operative nausea and vomiting, etc.). Using patient stratification, tailored surgical techniques and multimodal opioid-sparing analgesia, day-case TKA might be achievable in a limited group of patients. The younger, male patient without comorbidities and with an excellent social network around him might be a candidate. Demographic changes, effective recovery programmes and less invasive surgical techniques such as unicondylar knee arthroplasty, may increase the size of the group of potential day-case patients. The cost reduction achieved by day-case TKA needs to be balanced against any increase in morbidity and mortality and the cost of advanced follow-up at a distance with new technology. These factors need to be evaluated before adopting this ultimate 'fast-track' approach.
authors.affiliation: Catholic University of Louvain Cliniques Universitaires St-Luc, Av Hippocrate 10, B-1200 Brussels, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Thienpont
authors.affiliation: Catholic University of Louvain Cliniques Universitaires St-Luc, Av Hippocrate 10, B-1200 Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Lavand'homme
authors.affiliation: Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000556:Ambulatory Surgical Procedures; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment
keywords: knee arthroplasty fast-track same day surgery