When my patients ask whether they can really have a hip replaced and sleep in their own bed that night, the answer for most of them is yes. Outpatient hip replacement is no longer unusual. For healthy, prepared patients it has become a routine way to have this surgery.
Twenty years ago a hip replacement meant several days in the hospital. The operation itself has not changed much. What has changed is everything around it. Here is how I explain it in the office, including who should not do it this way.
What is outpatient hip replacement?
Outpatient hip replacement, also called same-day hip replacement, is a total hip replacement in which you go home the day of surgery instead of being admitted overnight. The technique, the implants and the goals are identical to an inpatient surgery. The difference is where you spend the first night.
The operation replaces the worn ball at the top of the thigh bone with a metal stem and a ceramic or metal head. The worn socket in the pelvis gets a metal cup and a durable liner. Together they restore the smooth motion an arthritic hip has lost.
I perform most outpatient hip replacements at the Bone and Joint Institute of Tennessee Surgery Center in Franklin. How the program works, from arrival to discharge, is on my outpatient joint replacement page.
Why is same-day hip replacement possible now?
Four advances made it safe and routine for the right patients:
- Better anesthesia and pain control. Spinal anesthesia numbs the area without the grogginess of general anesthesia. Numbing injections around the joint add hours of relief. Several non-opioid medications work together, with stronger medication only when needed. More on this in anesthesia for hip and knee surgery.
- Muscle-sparing technique. The anterior approach works between muscles instead of cutting through them, which means less tissue damage and an easier first walk.
- Less blood loss. Tranexamic acid, a medication that limits bleeding, has made transfusions rare.
- Early walking. Patients stand and walk within hours, not days. Early movement lowers the risk of blood clots and speeds the return to normal life.
I also use the Mako® robotic-assisted system to plan and place hip implants. Disclosure: I serve as a paid consultant to Stryker®, the company that makes Mako. That relationship does not affect which setting I recommend for any patient.
Dr. Cory Calendine and his surgical team performing outpatient hip replacement in Franklin, TN.Is outpatient hip replacement safe?
For the right patient, yes. A 2022 meta-analysis pooled 41 studies comparing outpatient and inpatient hip and knee replacement. It found no significant difference in overall complications, readmissions or patient-reported results in selected patients [1]. Other reviews have reached similar conclusions [2, 3].
The evidence is not one-sided, and you should know that. One meta-analysis found a higher overall complication rate with same-day discharge than with a short, fast-track hospital stay [4]. The authors of the larger review also note that many of the studies carry a real risk of bias [1].
The phrase that matters is “selected patients.” The good results come from choosing the right people. When a poor candidate is sent home the same day, the setting did not fail. The selection did.
Every hip replacement, in any setting, carries risks. They include infection, blood clots, dislocation, fracture around the implant, a difference in leg length, and nerve or blood vessel injury. These are uncommon, and careful technique and good preparation lower them further.
Who is a candidate for outpatient hip replacement?
Not every patient is a candidate, and that is a feature of the process, not a flaw. Age alone does not decide it. Overall health does.
Strong candidates for same-day surgery
- Good overall health, with medical conditions well controlled
- No severe heart, lung or kidney disease
- No untreated obstructive sleep apnea
- Blood sugar under control if they have diabetes
- Walking independently before surgery, with or without a cane
- A responsible adult at home for the first 24 to 48 hours
- A home they can move through safely
When outpatient hip replacement is not the right plan
Patients with significant heart failure, advanced lung disease, kidney failure, severe sleep apnea, or no reliable help at home are safer with an overnight stay. For them I operate at Williamson Medical Center, on the same campus as the surgery center. The surgery is identical. The only difference is a night of monitoring.
Some patients planned for same-day surgery stay overnight because of something unexpected. That flexibility is part of how the process stays safe. The checklist I use for knees works the same way, and I lay it out on Hospital or Surgery Center for Knee Replacement in Tennessee - How to Decide.
What happens on the day of surgery?
- Arrival. You check in early in the morning. The anesthesia team places your spinal anesthetic, and I review the plan with you.
- Surgery. The operation usually takes 60 to 90 minutes.
- Recovery and first walk. As the spinal wears off, a physical therapist helps you stand, walk with a cane or walker, and practice getting in and out of bed.
- Discharge. You go home when you can walk safely, your pain is controlled with oral medication, and your vital signs are stable. A friend or family member drives you.
Most patients are at the surgery center about four to six hours in all.
What is recovery at home like?
The first 48 hours. Rest, drink fluids, and take your pain medication on schedule instead of waiting for pain to build. Walk short distances around the house every hour or two while you are awake.
Weeks one and two. You walk a little more each day. Most patients can shower the day after surgery with a waterproof dressing in place. Do not soak the incision in a tub or pool. My post on the first two weeks after hip replacement covers this stretch in detail.
Weeks two to six. You return to light activity and short outings. Driving is usually allowed between two and four weeks, depending on which hip was done and how you feel. Many patients need less formal therapy than they expect, which I explain in hip replacement physical therapy.
Six weeks and beyond. Most patients walk without a cane or walker and are back to work and recreation. The last of your strength and stamina returns over three to six months.
How should you prepare for outpatient hip replacement?
Preparation matters more for same-day surgery than for any other approach. The goal is to walk into surgery healthy and walk out into a home that is ready for you.
- Set up one-level living if you can. Remove loose rugs and clear the walking paths.
- Have a sturdy chair with arms, and a raised toilet seat or shower bench if recommended.
- Pick up medications in advance and stock the kitchen with easy meals.
- Arrange a driver for surgery day and someone to stay with you for the first 24 to 48 hours.
- If you smoke, stop. If your blood sugar runs high, work with your primary care physician to bring it down.
Does outpatient hip replacement cost less?
Medicare and insurers pay a surgery center less than a hospital for the same operation. Whether that lowers your own bill depends on your coverage. It usually does for commercially insured and self-pay patients, and less so for traditional Medicare, where your share tends to be similar in either setting.
My team verifies your benefits and gives you an estimate before surgery. For real numbers, see what hip replacement costs.
When should you call after same-day hip replacement?
You go home with the on-call number. Call it, day or night, for any of these:
- Calf pain, or new swelling in the calf or thigh
- Chest pain or shortness of breath (call 911 first, then us)
- Fever, or chills that do not settle
- Drainage from the incision, or redness spreading away from it
- Pain that the medication plan is not controlling
- A fall, or a leg that suddenly will not bear weight
The full list, with the thresholds I use, is in hip replacement warning signs.
How long does a hip replacement last?
Longer than most people expect. A 2019 analysis in The Lancet, based on older implant designs, estimated that about 58 percent of hip replacements last 25 years [5]. A 2026 analysis of more than 1.9 million modern hip replacements across eight national registries estimated that about 92 percent are still in place at 30 years [6]. The 25-year and 30-year figures in that study are projections from 20 years of observed data, so treat them as an estimate, not a guarantee.
Where you recover the first night does not change how long the implant lasts. The quality of the surgery and the implant does.
Talk with Dr. Calendine about your options
If hip pain is limiting your life, come talk with me. We will go through your health, your home situation and your goals, and decide together whether outpatient hip replacement or an overnight stay is the safer plan. No referral is required. You can also read my broader guide to outpatient joint replacement surgery.
Bone and Joint Institute of Tennessee
3000 Edward Curd Lane, Franklin, TN 37067
(615) 791-2630
Schedule a consultation with Dr. Calendine
Want Dr. Calendine’s articles to stand out in your Google and AI search results? Add him as a preferred source (one tap).
Medical disclaimer: This article is for educational purposes only and is not a substitute for personal medical advice. Whether same-day surgery is appropriate depends on your individual health and is decided with your orthopaedic surgeon. Individual results may vary. In a medical emergency, call 911.
References
- Bemelmans YFL, Keulen MHF, Heymans M, van Haaren EH, Boonen B, Schotanus MGM. Safety and efficacy of outpatient hip and knee arthroplasty: a systematic review with meta-analysis. Arch Orthop Trauma Surg. 2022;142(8):1775-1791. PMID 33587170. pubmed.ncbi.nlm.nih.gov
- Ponugoti N, Magill H. Safety, efficacy and cost-effectiveness of outpatient versus inpatient joint arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2025;26(1):349. PMID 40200196. pubmed.ncbi.nlm.nih.gov
- Pollock M, Somerville L, Firth A, Lanting B. Outpatient total hip arthroplasty, total knee arthroplasty, and unicompartmental knee arthroplasty: a systematic review of the literature. JBJS Rev. 2016;4(12):e4. PMID 28060788. pubmed.ncbi.nlm.nih.gov
- Li M, Luo R, Zeng Y, Wu Y, Liu Y, Wu L, Shen B. Same-day discharge arthroplasty has a higher overall complications rate than fast-track arthroplasty: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2022;142(6):1167-1176. PMID 34129118. pubmed.ncbi.nlm.nih.gov
- Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019;393(10172):647-654. PMID 30782340. pubmed.ncbi.nlm.nih.gov
- Pentland V, Thompson Z, Dayimu A, et al. Survivorship of modern total hip replacement to 30 years: systematic review, meta-analysis, and extrapolation of global joint registry data. Lancet. 2026;407(10531):855-866. PMID 41763743. pubmed.ncbi.nlm.nih.gov
