Elsevier

The Journal of Arthroplasty

Volume 34, Issue 8, August 2019, Pages 1823-1830
The Journal of Arthroplasty

Systematic Review & Meta-Analysis
The Efficacy and Safety of Inpatient Rehabilitation Compared With Home Discharge After Hip or Knee Arthroplasty: A Meta-Analysis and Systematic Review

https://doi.org/10.1016/j.arth.2019.04.001Get rights and content

Abstract

Background

Total hip and knee arthroplasties (THKAs) are successful procedures in managing end-stage arthritis when nonoperative treatments fail. The immediate postoperative period is an important time for the body to recuperate and rehabilitate. Studies have shown that early intensive rehabilitation can enhance recovery. Rehabilitation can be provided as inpatient rehabilitation (IR) or discharge with home rehabilitation. These options have been studied, but literature on the efficacy and safety of IR compared to home discharge is scarce, and evidence is not well established. This meta-analysis aims to compare the efficacy and safety of IR to home discharge with rehabilitation after THKA.

Methods

A multidatabase search was performed according to PRISMA guidelines. Data from studies assessing the efficacy and safety of IR and home as discharge destinations after THKA were extracted and analyzed.

Results

Fifteen studies were included, consisting of 37,411 IR patients and 172,219 home discharge patients. These studies had heterogeneous reporting methods, with some conflicting results. There was no clinically significant difference in clinical outcomes between the groups. Readmission was nearly 5 times (odds ratio = 4.87, 95% confidence interval = 3.24-7.33, P < .001) and periprosthetic complications nearly 3 times (odds ratio = 2.82, 95% confidence interval: 1.54-5.24, P < .001) higher in IR patients than those discharged home after THKA.

Conclusion

Although IR is associated with higher risks of complications and readmissions, this may be because of patient selection bias in the clinical setting. Following THKA, it is safe to discharge patients to home with rehabilitation whenever possible.

Evidence level

Level II, Meta-analysis of heterogeneous studies.

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.

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    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.

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