Discharge to Inpatient Rehab Does Not Result in Improved Functional Outcomes Following Primary Total Knee Arthroplasty

• Published in: The Journal of arthroplasty 2018-06, Vol.33 (6), p.1663-1667
• Main Authors: Padgett, Douglas E., Christ, Alexander B., Joseph, Amethia D., Lee, You-Yu, Haas, Steven B., Lyman, Stephen
• Format: Article
• Language: English
• Subjects: Arthroplasty, Replacement, Knee - rehabilitation; Arthroplasty, Replacement, Knee - statistics & numerical data; Cohort Studies; Comorbidity; Costs and Cost Analysis; discharge location; Female; functional outcomes; Hospitals, Rehabilitation - statistics & numerical data; Humans; inpatient rehabilitation; Inpatients; Male; Patient Discharge - statistics & numerical data; Patient Reported Outcome Measures; Postoperative Period; primary total knee arthroplasty; Propensity Score; rehabilitation; Skilled Nursing Facilities - statistics & numerical data; Surveys and Questionnaires; Treatment Outcome
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.12.033

Monitored rehabilitation has long been considered an essential part of the recovery process in total knee arthroplasty (TKA). However, the optimal setting for rehabilitation remains uncertain. We sought to determine whether inpatient rehabilitation settings result in improved functional and patient-reported outcomes after primary TKA. All patients undergoing primary TKA from May 2007 to February 2011 were identified from our institutional total joint registry. Propensity score matching was then performed, resulting in a final cohort of 1213 matched pairs for discharge destination to either home or a rehabilitation facility (inpatient rehab or skilled nursing facility). Length of stay, need for manipulation, 6-month complications, and 2-year Western Ontario and McMaster Universities Osteoarthritis Index, Lower Extremity Activity Scale, 12-item Short Form Health Survey, and Hospital for Special Surgery knee expectations surveys were compared. Patients discharged to a rehab facility were noted to have a shorter hospital length of stay (5.0 vs 5.4 days). Patients discharged to inpatient rehabilitation reported more fractures at 6 months postoperatively. However, no differences in manipulation rates, 2-year outcome scores, or changes in outcome scores were found between the 2 groups. Inpatient rehabilitation settings did not result in lower complications at 6 months or improved functional or patient-reported outcomes at 2 years compared to discharge directly to home when patients are propensity matched for age, living situation, comorbidities, baseline functional status, and insurance status. This finding has important cost implications and calls into question whether the healthcare system should allow otherwise healthy patients to use inpatient rehabilitation services postoperatively after primary TKA.