Targeted early rehabilitation at home after total hip and knee joint replacement: Does it work?

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Abstract
Purpose. This study evaluates the benefits of targeted early rehabilitation at home after total hip or knee replacement surgery and analyses the cost effectiveness of such a scheme. Method. Patients recovering from Total hip replacement (THR, n = 220) and Total knee replacement (TKR, n = 174) were assessed in a NHS District General Hospital setting. Suitability of patients for early rehabilitation at home scheme (RAHS) was assessed at the pre-operative clinic by rehabilitation team. Length of in-patient stay (LOSH), duration on the scheme, number of bed days saved, cost appraisal, readmission rates and complications were recorded. Results. Targeted early rehabilitation resulted in reduced hospital stay (from 14 – 8.17 days for THR and from 12 – 8.21days for TKR), without any increase in complication rates. Significance testing revealed no statistical difference between the patient groups with regards to age, residence status, mobility and transfer ability on their length of stay in hospital or on the rehabilitation scheme. The patients who underwent total knee replacement required significantly more number of visits by the rehabilitation team than those who underwent total hip replacement (p value < 0.05). This resulted in an overall saving of £301,124 for the trust over the study period. Conclusions. Targeted early rehabilitation resulted in reducing the length of hospital stay without an increase in complication rates. The use of such a scheme brought significant savings to the trust without an increase in readmission rates.