Orthostatic intolerance following total joint arthroplasty remains a significant barrier to successful same-day discharge: a narrative review of an underreported complication

Abstract

Early mobilisation following total joint arthroplasty is crucial in considering patients for successful same-day discharge (SDD). Recent years have seen an increase in SDD after total joint arthroplasty, with complication rates comparable to those with prolonged hospital stays. Orthostatic intolerance (OI) is a significant barrier to successful SDD after total hip and knee arthroplasties, with up to 52% of patients experiencing it. Patient-related factors include being female, being elderly, having multiple comorbidities, possessing a higher American Society of Anesthesiologists (ASA) status, experiencing pain levels exceeding 5/10, and using gabapentin. Surgery-related risk factors identified were spinal anaesthesia versus general anaesthesia, hip replacement versus knee replacement, and postoperative opioid use. Non-pharmacological and pharmacological approaches can be used to categorise management strategies. However, no treatment has conclusively proven to address OI fully.