Same-day discharge total hip arthroplasty through the direct anterior approach using a standardised pathway: safety and reproducibility in three hundred eighty-four consecutive cases.

PURPOSE: Hip arthroplasty performed as a same-day discharge (SDD) procedure is gaining ground, but evidence in large, exclusively anterior-approach cohorts remains limited. Our hypothesis is that outpatient total hip arthroplasty (THA) via the direct anterior approach, performed in a high-volume academic centre with a standardised institutional pathway, is a safe and reproducible practice. METHODS: We conducted a retrospective single-centre study of all primary THAs performed on an outpatient basis via the direct anterior approach between January 2022 and October 2025. Epidemiological data, peri-operative parameters, and complications occurring within 60 days following surgery were recorded. RESULTS: Three hundred and seventy-nine patients (384 procedures) were included. Mean age was 63.1 ± 11.6 years and mean body mass index (BMI) was 26.2 ± 4.3 kg/m2. The SDD success rate was 97.7% (375/384). The most frequent causes of SDD failure were orthostatic hypotension (44.4%), uncontrolled pain (22.2%), and acute urinary retention (22.2%). The 60-day readmission rate was 1.3% (n = 5) and the emergency department visit rate was 1.8% (n = 7). Twenty-five patients (6.5%) required an early unplanned consultation. Owing to the small number of failures, subgroup comparisons between SDD success and failure were underpowered to detect differences in demographic parameters. CONCLUSION: These results suggest that same-day discharge THA via the direct anterior approach is feasible in selected patients treated within a standardised pathway, but further prospective studies are needed to confirm generalisability.