April 23, 2026
3 min read
Key takeaways:
- The number of outpatient TJA programs in the United States is rapidly increasing.
- Surgeons must take the necessary steps to run a successful outpatient TJA program.
Across the country, there is an increase in same day discharge and outpatient total joint arthroplasty programs.
But according to Ugo N. Ihekweazu, MD, FAAOS, FAAHKS, chief of adult hip and knee reconstruction at Texas Orthopedic Hospital and a partner of the Fondren Orthopedic Group in Houston, Texas, the trend is only natural.
“It is a natural evolution of joint replacement that has been driven by better implants, less invasive surgical techniques, better anesthesia pathways and pain control,” Ihekweazu told Healio. “The other thing that comes with it is that patients like going home the same day. From a hospital’s perspective, that translates to better value in terms of an overall reduction in resources that are necessary for the hospital.”
He continued, “If you are thinking about it from all the different stakeholders’ perspectives, the patients have a better experience, the surgical teams have a better experience, and the overall system at large in terms of hospitals and payers see value in it.”
Healio spoke with Ihekweazu about the growth of nationwide outpatient TJA programs and the prerequisites to run one successfully.
Healio: How important are safety and outpatient care pathways when building out an outpatient TJA program?
Ihekweazu: It is a big deal. The way we always frame it is that it is a team sport. It is not a surgeon-only achievement. The key element is the preoperative education provided by our nursing staff. We have a “no surprises” philosophy, which is where the patients know exactly what they are getting into prior to surgery. All the family and support systems for those patients are onboard, as well. Preoperatively, we put a huge emphasis on education. The optimization clinics are a big deal. That is part of the pathway. We want to make sure patients are medically appropriate for outpatient surgery from a nutrition standpoint, make sure people do not smoke and all the other things that could cause a disruption in their care.
Then, perioperatively it takes a long time, and it is an iterative process, but we put a huge emphasis on standardized protocols. That is preoperative medications, intraoperative medications, anesthesia modalities and then postoperative physical therapy and medications and making sure patients are safe to go home.
There is a lot that goes into these pathways, and it is definitely multidisciplinary. We have nursing, surgical staff, anesthesia, physical therapy and all the other stakeholders playing a huge role in creating these pathways and making sure patients are doing well.
Healio: How important is patient selection for outpatient TJA and which patients tend to be more suited for this program?
Ihekweazu: From my standpoint, every patient is a candidate, but not every patient may be ready for it.
Our goal is not to exclude patients, but to optimize individuals. We want to identify those candidates in clinic. Motivated patients with good social support systems and well-controlled comorbidities are the obvious candidates, but those who may not be as obvious are the patients we spend extra time with in the outpatient setting to get everything in order so that they can be a good candidate for outpatient surgery. Outpatient is not one size fits all. From our standpoint, inpatient care still plays a role.
If someone is at a point in their medical comorbidities or their social support system where outpatient surgery does not make sense, we still want to be able to offer them surgery and offer them a life without pain. For those patients, inpatient is reasonable to offer them, as well.
Healio: What are some of the bigger external sociodemographic factors that can affect patient selection?
Ihekweazu: It takes a village. Age, medical comorbidities, support system, geography and travel distance are all huge variables that can impact the success of a patient being able to make it home the same day. These are all factors that we try to address preoperatively and have nuanced conversations with the patients preoperatively. Social determinants of health also play a factor in these results. These are all things that are critical to addressing and thinking about when establishing an outpatient total joint program.
Healio: Do you have any other key take–home messages or advice to people building an outpatient TJA program?
Ihekweazu: We always say start small. The most successful programs start with a narrow, well-defined patient population, and then it is an iterative process. What works at our facility may not work someplace else in the country. You want to be able to refine your processes well, and the way you do that is by studying how your patients do. You have to create outcome measures and be honest about the data. You want to track what matters most, such as readmission, complications, satisfaction scores and patient-reported outcomes.
If you can track that data, you can refine the process and expand gradually. This is something we have been working on at our facility for more than a decade, and we are still tinkering with the process and making changes throughout the year, every single year. It is an iterative process and something that is refined over time.
For more information:
Ugo N. Ihekweazu, MD, FAAOS, FAAHKS, can be contacted at ugonna.ihekweazu@fondren.com.
Sources/Disclosures
Source:
Healio Interviews
Disclosures:
Ihekweazu reports no relevant financial disclosures.
Ask a clinical question and tap into Healio AI’s knowledge base.
- PubMed, enrolling/recruiting trials, guidelines
- Clinical Guidance, Healio CME, FDA news
- Healio’s exclusive daily news coverage of clinical data
<
Leave a Reply