Systematic Review & Meta-AnalysisThe Efficacy and Safety of Inpatient Rehabilitation Compared With Home Discharge After Hip or Knee Arthroplasty: A Meta-Analysis and Systematic Review
Section snippets
Literature Search
This meta-analysis was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses criteria [13]. A comprehensive search was conducted across multidatabases (PubMed, OVID Medline, EMBASE) from the date of database inception to 29th November 2018. The Medical Subject Heading and Boolean operator terms utilized for the search were as follows: [(‘Total hip arthroplasty’ OR ‘Total hip replacement’ OR ‘Total knee arthroplasty’ OR ‘Total knee replacement’) AND
Literature Search
A selection process flowchart to identify included studies is illustrated in Figure 1. A total of 830 studies were identified from the initial search, of which 158 duplicates and 26 non-English language articles were removed. Titles and abstracts of 646 remaining studies were screened in accordance to the predefined inclusion criteria. A total 15 studies [8], [9], [10], [11], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26] were included, consisting of 2 RCTs [8], [16], 7
Discussion
In this meta-analysis, we analyzed the available evidence from 2 RCTs, 12 cohort studies, and 1 case-controlled study comparing various outcomes of patients who received IR or were discharged with home rehabilitation following THKA.
Conclusion
Although IR is associated with a higher risk of complications, readmissions, and higher costs, this may have been because of selection bias. Following THKA, it is safe to discharge patients to home with rehabilitation whenever possible though further research is required to establish if this is true for all patients undergoing THKA.
References (39)
Treatment strength in rehabilitation
Arch Phys Med Rehabil
(1997)- et al.
Functional gains and therapy intensity during subacute rehabilitation: a study of 20 facilities
Arch Phys Med Rehabil
(2002) - et al.
Predictors and cost of readmission in total knee arthroplasty
J Arthroplasty
(2018) - et al.
Discharge to inpatient facilities after total hip arthroplasty is associated with increased postdischarge morbidity
J Arthroplasty
(2017) - et al.
A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after lower-extremity joint replacement surgery
Arch Phys Med Rehabil
(2011) - et al.
Discharge to inpatient rehab does not result in improved functional outcomes following primary total knee arthroplasty
J Arthroplasty
(2018) - et al.
The effect of discharge disposition on 30-day readmission rates after total joint arthroplasty
J Arthroplasty
(2014) - et al.
Characterizing rehabilitation services for patients with knee and hip replacement in skilled nursing facilities and inpatient rehabilitation facilities
Arch Phys Med Rehabil
(2009) - et al.
Predicting risk of extended inpatient rehabilitation after hip or knee arthroplasty
J Arthroplasty
(2003) - et al.
Risk factors for falls during inpatient rehabilitation
Am J Phys Med Rehabil
(2008)
Cost analysis of debridement and retention for management of prosthetic joint infection
Clin Microbiol Infect
Medicare funding for inpatient rehabilitation: how did we get to this point and what do we do now?
Arch Phys Med Rehabil
Home discharge after primary elective total joint arthroplasty: postdischarge complication timing and risk factor Analysis
J Arthroplasty
Patient satisfaction after total knee arthroplasty
Knee Surg Relat Res
Estimating the societal benefits of THA after accounting for work status and productivity: a markov model approach
Clin Orthop Relat Res
Patient satisfaction after total knee replacement: a systematic review
HSS J
Determinants of satisfaction 1 year after total hip arthroplasty: the role of expectations fulfilment
BMC Musculoskelet Disord
Increase in total joint arthroplasty projected from 2014 to 2046 in Australia: a conservative local model with international implications
Clin Orthop Relat Res
Effect of inpatient rehabilitation vs a monitored home-based program on mobility in patients with total knee arthroplasty: the HIHO randomized clinical trial
JAMA
Cited by (20)
Outpatient Total Knee Arthroplasty Shows Decreasing Complication Burden From 2010 to 2020
2023, Journal of ArthroplastyEfficacy and cost-effectiveness analysis of post-acute care for elderly patients with hip fractures
2022, Journal of the Formosan Medical AssociationCitation Excerpt :The home-based PAC group had lower costs compared to the hospital-based group. Patients who acquired PAC in the hospital had higher costs than those at home,14,35 with prolonged hospital stay and hospital-acquired infection as possible reasons. One study showed that patients and their families paid much money on direct non-medical cost, especially for informal home care after hospitalization in China.36
Why and How to Demonstrate the Value of Rehabilitation Services
2022, Archives of Physical Medicine and RehabilitationCitation Excerpt :Furthermore, they found that hospitals with high readmission rates and shorter stays had higher institutional PAC use, and hospitals with longer average length of stays used institutional PAC less frequently.12 Although studies have compared the costs and patient outcomes by type of PAC setting or by rehabilitation treatment intensity, these observational studies had several limitations.13-26 Furthermore, research to identify the costs and effectiveness of specific rehabilitation interventions with dosing recommendations has been limited.27
The application of whole-body vibration training in knee osteoarthritis
2022, Joint Bone SpineCitation Excerpt :However, further clinical trials are needed to determine whether it can be applied in clinical practice. Partial versus total knee replacement is often chosen for serious KOA, but post-operative rehabilitation and the uncertain life of prosthesis are the significant problems [4]. Drug analgesic therapy is still the primary treatment for the early and middle stages of KOA.
Early and Direct Rehab Transfer Leads to Significant Cost Savings and Decreased Hospital Length of Stay for Total Joint Arthroplasty in a Veteran Population
2021, Journal of ArthroplastyCitation Excerpt :An institutional joint registry of primary TKAs indicated that IPR did not result in fewer complications at 6 months or improve functional or patient-reported outcomes at 2 years compared with discharge directly to home [13]. A meta-analysis from Australia found an increase in complications and readmission with inpatient rehab patients versus those discharged directly to home with outpatient rehab, but this may have been secondary to patient selection bias [14]. A database study of over 100,000 patients examined postdischarge adverse events in elective TJA patients based on discharge destination and found a significantly higher rate of adverse events in patients discharged to SNF or IPR [15].
Greater risks of complications, infections, and revisions in the obese versus non-obese total hip arthroplasty population of 2,190,824 patients: a meta-analysis and systematic review
2020, Osteoarthritis and CartilageCitation Excerpt :Interestingly, it is noted that the significantly higher rate of discharge to IRF in obese patients could also be a driver of complications post THA. A recent meta-analysis by Onggo78 found that patients discharged to IRF have 4.87 and 2.82 times the risk of readmissions and peri-prosthetic complications (including dislocations) post joint replacement surgeries. Hence, discharge destination may be a significant confounder of this result.
No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.04.001.