Daycase Hip and Knee Arthroplasty in Møre and Romsdal Trial

The increasing demand for hip and knee arthroplasty has created a need for more efficient perioperative pathways without compromising patient safety, recovery, or satisfaction. Advances in surgical technique, anaesthesia, multimodal analgesia, early mobilization, and structured follow-up have made discharge on the day of surgery feasible for selected patients. However, the proportion of patients who can complete a day-case pathway in routine clinical practice, and the reasons why intended same-day discharge is not achieved, may vary between hospitals and patient populations.

The DART Study will evaluate the implementation of a standardized day-case arthroplasty pathway across three hospitals within Møre og Romsdal Hospital Trust: Sjukehuset Nordmøre og Romsdal at Hjelset, Ålesund Hospital, and Volda Hospital. The study will include patients scheduled for primary total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty. The study is investigator-initiated and embedded in ordinary clinical care.

All patients scheduled for one of the eligible procedures during the recruitment period will be screened prospectively. Screening will document whether the patient fulfils the predefined criteria for participation in the day-case pathway.

The predefined eligibility assessment will include relevant medical, functional, cognitive, and logistical factors. Factors expected to preclude participation in the day-case pathway include severe systemic disease, advanced frailty, impaired cognition or inability to comply with instructions, body mass index above 40 kg/m², age above 80 years, and travel circumstances that make rapid access to an acute hospital difficult. Final eligibility will be determined by the treating clinical team according to the study criteria and an individual clinical assessment.

Patients included in the day-case pathway will receive standardized preoperative information and preparation. The perioperative pathway is designed to support early recovery and includes evidence-based anaesthesia, multimodal opioid-sparing analgesia, early oral intake, and mobilization shortly after surgery. Regional analgesic techniques will be adapted to the type of procedure. Patients undergoing knee arthroplasty will receive a genicular nerve block and femoral triangle block as part of the pain-management pathway. Patients undergoing total hip arthroplasty will receive a pericapsular nerve group block. The use and effect of the regional block will be documented. After a pericapsular nerve group block, the ability to perform active knee extension while sitting will be assessed as an indicator of quadriceps motor function.