Purpose: Due to recent shifts in healthcare reimbursement models, more primary total hip arthroplasties (THAs) are now being performed in the outpatient setting. However, there is a lack of knowledge around the comparative outcomes of revision outpatient THA. Materials and Methods: Adults undergoing revision THA between 2010 and 2020 with 2-year follow-up data were identified on a large insurance claims database. Following stratification by inpatient versus outpatient revision THA, patients from both groups were matched 1:1 by demographics and revision characteristics. Ninety-day postoperative medical and 1- and 2-year postoperative surgical complications after matching were compared. Results: Among 67,570 patients, mean age was 65.3 years, 57.0% were female, and mean Charlson comorbidity index score was 1.72. Subsequent to 1:1 matching, 1,555 inpatient and outpatient revision THA patients were identified. Outpatient THA patients had significantly lower rates of blood transfusions (3.6% vs 5.1%, P=0.049), broken prosthesis (1 year: 0.1% vs.0.6%, P=0.027; 2 years: 0.2% vs. 0.9%, P=0.015), and other postoperative mechanical complications (1 year: 4.9% vs. 7.1%, P=0.010; 2 years: 6.2% vs. 8.4%, P=0.023). Otherwise, the data for outpatient THA patients was not statistically different from inpatient THA patients across all studied complications. Conclusion Outpatient revision THA may be a safe alternative to inpatient revision THA for carefully selected patients. Establishing patient- and case-specific parameters to optimize outcomes, satisfaction, safety, and value is critical.

Purpose: In the existing literature, isolated femoral head and polyethylene liner exchange is commonly performed in revision total hip arthroplasty (THA) for a variety of indications with mixed outcomes. The purpose of this study is to investigate patient outcomes following head-liner exchange and risk factors associated with failure in THA. Materials and Methods: A retrospective chart review from May 2016 to November 2023 was conducted on patients who underwent isolated head-liner exchange at two institutions. Patients had minimum 1-year follow-up periods. For each patient, data such as indication for revision, surgical approach, revision head size, immediate and short-term complications, postoperative disposition, 90-day readmissions, and re-operations were recorded. Results: Out of 175 patients, there were 24 readmissions/emergency department visits within 90 postoperative days (13.7%), 21 subsequent revision surgeries (12.0%), 21 postoperative dislocations (12.0%), and 20 immediate postoperative complications (11.4%). A statistically significant association was demonstrated between indication for revision and postoperative instability (P=0.04). Patients operated upon for instability had higher rates of postoperative instability. Furthermore, patients with reported preoperative dislocation events had higher incidences of postoperative dislocations. Patients discharged to skilled nursing facilities (SNF) were associated with an increased number of hospital readmissions within 90 days of surgery, reoperation, and postoperative dislocation (P<0.05). No statistically significant associations were found between surgical approach and complications. Conclusion This study suggests that, in the context of isolated head-liner exchanges, factors such as preoperative dislocation history, indication for revision, and discharge to SNF are associated with poorer outcomes and complications.

Purpose: Chloroprocaine spinal anesthetic may facilitate quicker postoperative recovery in total hip arthroplasty (THA) than mepivacaine due to its shorter duration of action and rapid metabolization, which could reduce time to ambulation and discharge. Given the increasing emphasis on same-day discharge (SDD) protocols in THA to improve efficiency and reduce healthcare costs, evaluating the impact of chloroprocaine on discharge timing and postoperative outcomes is critical. This study compared the clinical outcomes and safety of chloroprocaine compared to mepivacaine in SDD primary THA. Materials and Methods: This retrospective study compared the spinal anesthesia used on 226 patients who underwent primary THA performed between November 2020 to June 2023. The surgical outcomes of chloroprocaine (n=97) versus mepivacaine (n=129) spinal anesthesia, including estimated blood loss (EBL), operative time, discharge time, and 90-day readmissions or emergency department visits, were assessed. Anesthesia-related complications such as hypotension, bradycardia, urinary retention, and post anesthesia care unit outcomes were also documented. Results: Baseline characteristics were similar between groups. The chloroprocaine group had significantly lower EBL, shorter operative times, and faster discharge times. No significant differences were observed between groups in anesthesia complications or postoperative nausea, vomiting, or headaches. Additionally, there were no differences in surgical complications. Conclusion For direct anterior approach primary THA, chloroprocaine spinal anesthesia was associated with reduced blood loss, shorter operative times, and faster SDD, with no cases of unplanned direct admissions. These results indicate that chloroprocaine spinal anesthesia can be utilized as a safe and effective alternative to mepivacaine in outpatient THA.