Home Beats Rehab for Knee, Hip Replacement Recovery

Research shows patients fare well, sometimes better, if discharged home, even if they live alone

Thursday, March 16, 2017

THURSDAY, March 16, 2017 (HealthDay News) -- Patients who go straight home from the hospital following hip or knee replacement surgery recover as well as, or better than, those who first go to a rehabilitation center, new research indicates.

And that includes those who live alone without family or friends, one of three studies shows.

"We can say with confidence that recovering independently at home does not put patients at increased risk for complications or hardship, and the vast majority of patients were satisfied," said that study's co-author, Dr. William Hozack. He is an orthopaedic surgery professor with the Rothman Institute at the Thomas Jefferson University Medical School in Philadelphia.

Hozack noted that while in the past it was "not uncommon for patients to enter a rehabilitation facility in order to receive additional physical therapy," most patients today do not end up going to a secondary facility.

In fact, roughly 90 percent of Hozack's joint replacement patients are discharged directly home following surgery, he said.

"Considerable evidence has now shown that most patients do just as well at home," he noted.

Hozack and his colleagues are scheduled to present their findings Thursday in San Diego at a meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Two other studies being presented at the meeting also found that recovering at home may be the better option.

One study found that patients who are discharged directly home following a total knee replacement face a lower risk for complications and hospital readmission than those who first go to an inpatient rehab facility. The study was led by Dr. Alexander McLawhorn, an orthopaedic hip and knee surgeon at the Hospital for Special Surgery in New York City.

McLawhorn was also part of a second Hospital for Special Surgery study, led by Michael Fu. That study found that hip replacement patients admitted to an inpatient facility rather than being sent home faced a higher risk for respiratory, wound and urinary complications, and a higher risk for hospital readmission and death.

Dr. Claudette Lajam is chief orthopaedic safety officer with NYU Langone Orthopaedics in New York City. She was not involved with the studies, but agrees that home recovery is the best option for most patients.

"The home setting is the single best way to get people back into their routines as quickly as possible after surgery," she said.

"In some cases, this cannot be done," Lajam acknowledged. "Some patients live in settings that are inaccessible, [such as] a 5th-floor walk-up apartment where the patient would need to go downstairs to let the visiting nurse and therapist in the door." For some patients, anxiety about the recovery process could also pose a challenge, she added.

But "being in an institutional setting after surgery only reinforces the idea that the patient is 'sick,' " Lajam added. "We have learned that this type of thinking slows down recovery. We want our total joint patients to start using their new joints as quickly as possible, and staying in bed at a nursing facility is not the way to do this."

Because home environments vary, Hozack and his colleagues set out to see whether patients who live alone fare as well as those who live with others.

All 769 patients enrolled in the study by Hozack's team went home following either a total hip replacement or a total knee replacement. Of those, 138 lived alone (about 18 percent).

Once home, all were assessed on multiple levels, including functionality (ability to move); pain levels; hospital readmissions; emergency department visits; unscheduled doctor visits; dependency on assisted-walking devices; and time before returning to work or being able to drive again.

Hozack's team observed no differences by any measure. And while those who lived with others indicated relatively higher satisfaction levels at the two-week mark, by the three-month point there was no appreciable difference between the two groups.

"We feel that giving patients back their independence early on is the best way to promote a safe and effective recovery," said Hozack. His team concluded that single-household patients who go straight home can expect to fare as well as those who have live-in support.

A recent Mayo Clinic study calculated that between 2000 and 2010, the number of Americans who underwent hip replacement surgery more than doubled, rising from just under 140,000 to more than 310,000 per year.

Meanwhile, AAOS figures indicate that in 2010 more than 650,000 knee replacement procedures were performed, with about 90 percent involving total knee replacement.

AAOS estimates from 2014 show that 4.7 million Americans now live with an artificial knee and 2.5 million have an artificial hip.

Findings presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

SOURCES: William J. Hozack, M.D., professor of orthopaedic surgery, Rothman Institute, Thomas Jefferson University Medical School, Philadelphia; Claudette Lajam, M.D. assistant professor and chief orthopedic safety officer, NYU Langone Orthopedics, New York City; March 14-18, 2017 presentations, American Academy of Orthopaedic Surgeons meeting, San Diego

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