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Richard Peter Almeida Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

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Lipalo Mokete Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

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Nkhodiseni Sikhauli Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

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Allan Roy Sekeitto Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

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Jurek Pietrzak Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

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Introduction Primary total joint arthroplasty (TJA), including total hip arthroplasty (THA) and total knee arthroplasty (TKA), are highly successful, reproducible surgical procedures. The demand for TJA is increasing globally, with projections

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Mark D Kohn Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, Washington, USA

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Charles J Wolock Department of Biostatistics, University of Washington, Seattle, Washington, USA

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Isaac J Poulson School of Medicine, University of Washington, Seattle, Washington, USA

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Navin D Fernando Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, Washington, USA

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been shown to incur some of the highest costs of care as reflected by reimbursements during the 90-day global period ( 2 ). With projected annual rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) expected to increase exponentially

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R J M Morrison Northumbria Healthcare NHS Foundation Trust, Ashington, UK
Newcastle University, Newcastle upon Tyne, UK

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W G Fishley Northumbria Healthcare NHS Foundation Trust, Ashington, UK
University of York, York, UK

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K S Rankin Newcastle University, Newcastle upon Tyne, UK
The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

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M R Reed Northumbria Healthcare NHS Foundation Trust, Ashington, UK
University of York, York, UK

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been associated with a range of adverse post-operative outcomes ( 3 ), and there is a high incidence of deficiency reported in patients undergoing total hip (THR) or knee (TKR) arthroplasty ( 4 ). Previous systematic reviews ( 4 , 5 , 6 , 7 ) have

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E. Carlos Rodríguez-Merchán Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain

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outpatient TKA than inpatient TKA, including component failure, surgical site infection, knee stiffness and deep vein thrombosis. 14 According to Gogineni et al, outpatient total hip arthroplasty (THA) and TKA in a well-selected patient is feasible in

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Nicola Ratto University of Torino, Italy

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Chiara Arrigoni University of Torino, Italy

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Federica Rosso AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy

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Matteo Bruzzone AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy

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Federico Dettoni AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy

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Davide Edoardo Bonasia AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy

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Roberto Rossi AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy

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expected. 2 Differing causations hase been reported for TJA failure and revision. 3 , 4 According to recent data, peri-prosthetic joint infection (PJI) incidence constitutes between approximately 0.3% and 1.7% of all total hip arthroplasties (THA

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Vikki Wylde Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, UK.
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK.

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Andrew Beswick Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, UK.

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Julie Bruce Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, UK.

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Ashley Blom Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, UK.
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK.
North Bristol NHS Trust, Southmead Hospital, Bristol, UK.

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Nicholas Howells North Bristol NHS Trust, Southmead Hospital, Bristol, UK.

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Rachael Gooberman-Hill Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, UK.
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK.

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found to be associated with an almost three-fold risk of moderate to severe chronic pain after surgery compared with other surgical procedures. 6 Within orthopaedics, the prevalence of chronic pain after TKA is much higher than after total hip

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Olivier Courage Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France

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Louise Strom ReSurg SA, Nyon, Switzerland

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Floris van Rooij ReSurg SA, Nyon, Switzerland

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Matthieu Lalevée Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France
Hôpital Charles Nicolle, CHU de Rouen, Rouen, France

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Donatien Heuzé Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France
Hôpital Charles Nicolle, CHU de Rouen, Rouen, France

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Pierre Emanuel Papin Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France
Hôpital Charles Nicolle, CHU de Rouen, Rouen, France

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Michael Butnaru Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France
Hôpital Charles Nicolle, CHU de Rouen, Rouen, France

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Jacobus Hendrik Müller ReSurg SA, Nyon, Switzerland

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review on the outcomes of total hip arthroplasty and TKA, and found higher risks of complications and mortality in older patients. In 2016, Kuperman et al 17 published a meta-analysis of comparative studies performed over the two preceding decades and

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David Constantinescu Department of Orthopaedics, University of Miami, Miami, Florida, USA

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William Pavlis University of Miami Miller School of Medicine, Miami, Florida, USA

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Michael Rizzo Department of Orthopaedics, University of Miami, Miami, Florida, USA

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Dennis Vanden Berge Department of Orthopaedics, University of Miami, Miami, Florida, USA

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Spencer Barnhill Department of Orthopaedics, University of Miami, Miami, Florida, USA

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Victor Hugo Hernandez Department of Orthopaedics, University of Miami, Miami, Florida, USA

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use following lower limb surgery. Two systematic reviews found that the current smartphone apps available for TKA and total hip replacement (THA) have significant variability in their quality and overall poor readability for patients ( 14 , 15

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Babar Kayani University College Hospital, London, UK
Princess Grace Hospital, London, UK

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Sujith Konan University College Hospital, London, UK
Princess Grace Hospital, London, UK

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Atif Ayuob University College Hospital, London, UK
Princess Grace Hospital, London, UK

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Elliot Onochie University College Hospital, London, UK

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Talal Al-Jabri University College Hospital, London, UK

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Fares S. Haddad University College Hospital, London, UK
Princess Grace Hospital, London, UK

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for total hip arthroplasty. 3 Despite advances in implant design, implant material, enhanced recovery programmes, thromboembolic prophylaxis, antibiotic prophylaxis, patient-specific implants, and computer navigation, recent studies have shown

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Vikki Wylde Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK

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Neil Artz Department of Allied Health Professions, University of the West of England, Bristol, UK

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Nick Howells North Bristol NHS Trust, Southmead Hospital, Bristol, UK

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Ashley W. Blom Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
North Bristol NHS Trust, Southmead Hospital, Bristol, UK

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, the NIHR or the Department of Health and Social Care. References 1. Tilbury C Haanstra TM Leichtenberg CS et al. Unfulfilled expectations after total hip and knee arthroplasty surgery: there is a need for

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