Screen every arthroplasty candidate with the questionnaire below. Patients who meet the Outpatient (ASC) criteria may have same-day/ambulatory surgery; those who do not, but meet the Inpatient criteria, are scheduled as inpatients. Inpatient thresholds are intentionally more permissive (older age, higher BMI/HbA1c, ASA III) because these patients are admitted and monitored.
1 · Candidacy Risk-Assessment Questionnaire
Must meet all of the following:
- Unilateral, uncomplicated, primary knee or hip arthroplasty
- ASA I or II; optimized ASA III acceptable with anesthesia review
- Preoperative body mass index < 36 kg/m²
- Age < 75 years at time of surgery (patients ≥ 75 are candidates for the inpatient pathway)
- No active liver disease or active kidney disease (preoperative GFR > 60)
- Well-controlled diabetes with HbA1c < 7 — insulin-dependent diabetics acceptable if optimized
- Albumin ≥ 3.5 g/dL
- No uncorrected moderate-to-severe peripheral vascular disease
- No intra-articular injection into the surgical joint within the last 3 months
- Assistance available at home 24 hrs/day for at least the first 3 days
- No poorly controlled or severe cardiac disease
- No chronic opioid use or history of opioid addiction
- No home oxygen
- No history of uncorrected urinary retention or difficult catheterization
- No history of significant opiate-related nausea (exception: nausea with one opioid but tolerates another)
Recommendations (not hard stops)
- No DVT, PE, TIA/stroke, MI, or other thromboembolic event within the last year
- Non-smoker
- Drinks fewer than 14 alcoholic beverages per week
Additional screening questions
- History of metal allergy?
- Taking Ozempic or another GLP-1? (hold per current perioperative guidance for aspiration risk)
Reference: Knee Surg Sports Traumatol Arthrosc. 2017 Sep;25(9):2668–2675. doi:10.1007/s00167-016-4140-z. PMID: 27106923.
2 · Outpatient (ASC) Criteria
All must be met for same-day / ambulatory-surgery-center arthroplasty:
- Unilateral, uncomplicated, primary hip or knee arthroplasty
- ASA I or II; optimized ASA III acceptable with anesthesiologist approval on chart review
- Preoperative body mass index < 36 kg/m²
- Age < 75 years at time of surgery
- Preoperative hemoglobin > 12 g/dL
- No seizure disorder, active liver disease, or active kidney disease (GFR > 60)
- Well-controlled diabetes with HbA1c < 7 — insulin-dependent diabetics acceptable if optimized
- Fewer than 14 alcoholic beverages per week
- No cardiopulmonary disease that would require inpatient monitoring after surgery
- No MI or stroke within the past 6 months. A remote, resolved, well-controlled event (e.g., a single prior DVT/PE, or MI/TIA/stroke > 6 months ago with good functional capacity) may proceed with cardiology/hematology clearance and risk-adjusted VTE prophylaxis
- Preoperative ambulatory status does not require a walker or wheelchair
- No chronic preoperative opioid use or history of opioid addiction
- No significant opiate-related nausea (exception as above)
- No contraindication to IV or oral NSAIDs
- Biologic/immunomodulatory medications (e.g., rheumatoid arthritis) managed case-by-case, held perioperatively per current guidelines
- Assistance available at home 24 hrs/day for at least the first 3 days after discharge
- No uncorrected moderate-to-severe PVD
- No other condition or circumstance that would preclude rapid discharge from the ASC
3 · Inpatient Criteria
All must be met for the inpatient pathway (intentionally more permissive than the ASC pathway — patients are admitted and monitored):
- Unilateral, uncomplicated, primary knee or hip arthroplasty
- ASA I–III (optimized); higher acuity acceptable with anesthesia review
- Preoperative body mass index < 40 kg/m²
- No strict upper age limit — older patients are appropriate here, individualized to overall health
- Preoperative hemoglobin > 12 g/dL
- No active liver disease or active kidney disease (preoperative GFR > 60)
- Well-controlled diabetes with HbA1c < 7.5
- Albumin ≥ 3.5 g/dL
- No uncorrected moderate-to-severe PVD
- No intra-articular injection into the surgical joint within the last 3 months
- Assistance available at home 24 hrs/day for at least the first 3 days, or appropriate for skilled-nursing-facility (SNF) discharge
Recommendations (not hard stops)
- No chronic preoperative opioid use or history of opioid addiction
- No MI or stroke within the past 6 months; a remote, resolved, well-controlled event may proceed with cardiology/hematology clearance and risk-adjusted VTE prophylaxis
- Fewer than 14 alcoholic beverages per week