Traditional beliefs among both patients and physicians about where to best recover from a total knee arthroplasty (TKA)—in the hospital or at home—are challenged by a study conducted in Australia by Justine Naylor, Ph.D., and Andrew Fleischman, M.D.
Home Rehab After TKA Equals Hospital Stay
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In a comparison of inpatient and home-based rehabilitation programs following total knee arthroplasty (TKA) they found that the recovery was very similar for many key factors, including pain relief and knee functioning.
The study involved 165 postsurgical patients, 81 of whom were randomized to a 10-day hospital inpatient program and 84 patients who went to a home-based program. An additional group of 87 chose the home-based program. Sixty-eight percent of the participants were women who had a mean age of 66 years. Researchers assessed the patients’ mobility at 26 weeks after surgery, with a 6-minute walk test.
They found that there was no significant difference in the 6-minute walk test between the inpatient and the two home-based programs. The researchers found similar findings for pain and function. The pain and function scores on average were more than double, meaning much greater improvement, noted Naylor. Complications after discharge were also higher for the inpatient group versus those receiving rehabilitation at home.
“I think everyone assumed that more intensive, more supervised therapy always leads to better recovery—either a quicker recovery or a greater absolute recovery—in any context,” Naylor told Kathleen Doheny, the writer for Practical Pain Management. “We did not see either of these things.”
Commenting on the unexpected similarity in outcomes between the groups, Naylor speculated that ”time is primarily variable dictating recovery.” She added that ”it is possible that the role of rehabilitation is to guide people about what to do, provide a point of regular and personal contact with a health professional so adverse events are detected, to encourage participation in activity, and to bring people together to share in their recovery as shared experiences normalize the process for the individual.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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