Bone Joint J 2015;97-B(10 Suppl A):40–4.

The constraints on day-case total knee arthroplasty: the fastest fast track

E. Thienpont, P. Lavand'homme, H. Kehlet

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.

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