Predictors of Discharge Home Versus Inpatient Rehabilitation Following Total Hip and Knee Arthroplasty-Cohort Study

This study aims to identify the prevalence of inpatient rehabilitation (IPR) use in an Australian private total joint arthroplasty (TJA) cohort and to identify factors predictive of IPR discharge, including components of the Risk Assessment and Prediction Tool (RAPT).

Primary TJA patients at a Sydney private hospital, between 2021 and 2022 were identified from an institutional arthroplasty database. Variables previously deemed as predictive factors for IPR facility discharge in the literature and components of RAPT were assessed utilising multivariable generalised linear model analysis.

Of the 733 total hip arthroplasty (THA) and 776 total knee arthroplasty (TKA) patients included, 46% of THA and 64% of TKA subjects transferred to IPR post-acutely. Bilateral procedure (OR 7.91, p < 0.001), living alone (OR 5.23, p < 0.001), older age groups (66-75 (OR 2.14, p = 0.001)); (> 75 (OR 5.02, p < 0.001)), poorer walking distance (1-2 blocks (OR 1.64, p = 0.023)); (housebound (OR 2.68, p = 0.009)), were significant predictors of IPR following THA. In the TKA cohort, the significant predictors of IPR discharge were female (OR 2.47, p < 0.001), older age (66-75 (OR 1.73, p = 0.021)); (> 75 (OR 4.23, p < 0.001)), bilateral procedure (OR 6.86, p < 0.001), obesity (OR 1.76, p = 0.006), living alone (OR 2.86, p = 0.001) and surgeon (surgeon 3 (OR 2.30, p = 0.024)); (surgeon 4 (OR 3.04, p = 0.003)); (surgeon 5 (OR 2.18, p = 0.046)).

The use of IPR following TJA was associated with some clinically justifiable factors, such as bilateral procedure, older age, and living alone. However, other variables may be driven by inappropriate and potentially modifiable societal expectations, such as being female, obesity, treating surgeon, and limited walking distance.