Total joint arthroplasty: a comparison of postacute settings on patient functional outcomes

This descriptive comparative study was conducted to examine functional outcomes of total joint arthroplasty patients discharged to subacute rehabilitation programs compared with those of patients discharged directly home with home physical therapy follow-up.

This study used a convenience sample of 96 patients having total joint arthroplasty performed by one physician within one institution. The postacute care setting was self-selected by the patients after information was provided on both options.

A patient self-evaluation questionnaire was administered preoperatively and at 1 month and 3 months after surgery. A total functional score was obtained by combining the four subscores of the questionnaire/tool: subjective, pain, walking, and activities of daily living. Quantitative data on length of stay and cost were collected for each rehabilitative site.

All patients improved significantly over time in all subscores and in total score. There was no statistically significant difference in scores between the home and the subacute group. There was a significant difference in the mean total cost of the joint replacement for the subjects who went to the subacute unit ($24,144) compared to those who went directly home ($16,918). The groups were significantly different demographically, with the subacute group being older (age > 72), and likely to have comorbidities and to live alone.

The majority of total joint replacement patients can achieve acceptable functional outcomes in a reasonable length of time at home with physical therapy supervision. Rehabilitation in a subacute facility may be most useful for the elderly patient with comorbidities, particularly those who live alone.