Same-day discharge after total hip arthroplasty (THA) is increasing, but patient-reported recovery remains incompletely characterized. Is outpatient management associated with higher early postoperative pain or inferior patient-reported functional recovery than inpatient management after direct anterior THA?

We hypothesized that outpatient management would not be associated with higher daily pain or inferior short-term patient-reported outcomes compared with inpatient management.

Patients and Methods: This single-surgeon observational cohort compared outpatient (0 overnight stays) and inpatient (≥1 night) management after primary direct anterior THA using standardized care and digital follow-up to D180. The intended pathway was planned preoperatively, and groups were defined by actual overnight stays. Outcomes were adjusted for demographic, comorbidity and preoperative score covariates, and the comparison was repeated with propensity-score overlap weighting.

Among 477 patients (297 outpatient, 180 inpatient), pain did not differ at D3, D7, D28 or D90 and was higher among inpatients at D180 (adjusted difference +0.28, p = 0.029), as was analgesic use (adjusted risk ratio 2.91, p = 0.004). At D180 the Simple Hip Value (−4.89, p = 0.016), modified Harris Hip Score (−2.49, p = 0.030) and HOOS-PS (−2.45, p = 0.029) favoured outpatients, as did return to leisure activity at D28, quality of life and recommendation of care. Both analytic approaches agreed on every outcome.

In selected patients managed within a standardized pathway, same-day discharge was not associated with higher pain or inferior patient-reported recovery to D180; the design does not support a causal benefit of outpatient management.

III; retrospective comparative study of prospectively collected data.