Anesthesia for Ambulatory Major Total Joint Arthroplasty: The Future is Now!

Purpose of Review: The rapidly growing demands for total joint arthroplasty and changes in healthcare have resulted in these surgical procedures being performed in an outpatient/short-stay setting. Recent Findings: For these procedures to be performed safely on an outpatient basis, it is necessary to implement multidisciplinary, multimodal protocols that improve functional outcomes, enhance recovery, and reduce the need for hospitalization. These protocols include appropriate patient selection, preoperative optimization of comorbid conditions, and patient education. In addition, use of minimally invasive surgical techniques along with fast-track anesthesia techniques as well as aggressive nonopioid multimodal analgesia and aggressive postoperative nausea and vomiting prophylaxis is necessary. Postoperatively, the focus is on early mobilization and accelerated physical therapy. Summary: Collectively, these fast-track methods result in an effective clinical pathway that improves outcomes and the patient experience. The purpose of this review article is to examine the perioperative considerations required for performing total hip and knee arthroplasties on an outpatient basis.