Seven studies (177,792 patients) were included in this meta-analysis comparing out-patients and in-patients undergoing a total joint arthroplasty (TJA). The primary outcomes of interest were the risk of total complications, major complications, re-admission, re-operation, deep vein thrombosis, urinary tract infection, pneumonia, wound complications and transfusions. Results revealed no significant differences between the out-patient and in-patient groups in the risk ratio for total complications, major complications, re-admission, urinary tract infection, and wound complications in the TJA analysis, as well as the total knee arthroplasty (TKA) and total hip arthroplasty (THA) sub-group analyses. The risk ratio for pneumonia and deep vein thrombosis were not significantly different between the two groups in the TJA analysis. There was a higher risk of re-operation but lower risk of transfusion in the out-patient group in the TJA analysis and TKA sub-group analysis, but not in the THA sub-group analysis.