Patients needing revision, or redo, joint replacement surgery used to almost always require a hospital stay.
But now they have more options.
The Indiana Orthopedic Institute specializes in revision surgery—where all or part of an existing artificial joint is replaced or repaired—with same-day discharge for many patients.
“It just turns out that the home is where you’re the safest,” said Indiana Orthopedic Institute Founder and CEO Dr. Michael Meneghini, who specializes in hip and knee revisions. “If you’re coming in for a musculoskeletal procedure, you’re not sick. You’re in need of care to fix your orthopedic issue, not a place to go when you’re sick.”
Revisions require specific surgical skills, different implants, and precise planning.
While a minority of overall joint replacement procedures are revisions, they are vitally important to those who need them.
Some patients who have undergone hip and knee replacement, often decades before, may need a second surgery. So-called revision surgery is performed to correct issues such as infection, injury, or problems with the implant that cause pain, instability, or reduced mobility.
Traditionally, patients who needed revision surgery after a previous hip or knee replacement stayed in the hospital for at least one night. The thinking was that such complicated surgery required inpatient care.
But at Indiana Orthopedic Institute, a significant portion of patients undergoing revision joint surgery go home the same day thanks to a highly coordinated, systematic approach to patient care.
Dr. Dave Conrad, Indiana Orthopedic Institute Director of Anesthesia, emphasized that the same tightly controlled protocols used for primary, or initial, joint replacement serve as the model for revisions. The goal is to control pain and emphasize mobility, he said.
“Performing successful revisions starts with performing successful primary surgeries,” Conrad said. The vast majority of primary joint replacement patients at Indiana Orthopedic Institute return home just hours after surgery.
Care for revision patients is guided by research:
Dr. Meneghini co-authored multiple peer-reviewed studies scrutinizing the safety and efficacy of revision surgery with brief hospital stays or same-day discharge:
- A 2020 study in the Journal of Arthroplasty focused on methods and safety, finding that modern perioperative protocols before, during, and after surgery with early discharge did not increase 90-day readmissions or emergency department visits.
- A 2022 study in Arthroplasty Today built on this by examining 35 patients (without infections) set for same-day discharge revisions, with 97% discharged on the same day.
- A 2025 study in the Journal of Arthroplasty examined pre-surgery evaluation to ensure safety and suitability of same-day discharge, a pillar of Indiana Orthopedic Institute’s approach. The research used the Outpatient Arthroplasty Risk Assessment (OARA) Score, a medical risk assessment tool co-invented and developed by Dr. Meneghini, finding that it was a significant predictor of same- or next-day discharge.
The research findings also underscore a major shift toward delivering more orthopedic care in outpatient centers.
In fact, the U.S. Centers for Medicare & Medicaid Services in January 2026 began a phase-out of its “Inpatient Only” list of procedures requiring hospitalization, starting with the removal of 285 musculoskeletal procedures including hip and knee revisions.
For many patients, that means more time at home and more options for care.
For more information, please visit indianaortho.comor call (317) 620-0232.