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

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

Onggo, James Randolph et al.
Hip Knee

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.

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