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


METHODS
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.


RESULTS
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.


CONCLUSION
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.
['Padgett|Douglas E|DE|', 'Christ|Alexander B|AB|', 'Joseph|Amethia D|AD|', 'Lee|You-Yu|YY|', 'Haas|Steven B|SB|', 'Lyman|Stephen|S|']
D019645:Arthroplasty, Replacement, Knee D015331:Cohort Studies D015897:Comorbidity D003365:Costs and Cost Analysis D005260:Female D000077773:Hospitals, Rehabilitation D006801:Humans D007297:Inpatients D008297:Male D010351:Patient Discharge D000071066:Patient Reported Outcome Measures D011184:Postoperative Period D057216:Propensity Score D012866:Skilled Nursing Facilities D011795:Surveys and Questionnaires D016896:Treatment Outcome
functional outcomes primary total knee arthroplasty rehabilitation inpatient rehabilitation discharge location