Comparison of Outcome Measures from Different Pathways Following Total Knee Arthroplasty

Overview

Journal Singapore Med J

Specialty General Medicine

Date 2018 Jan 27

PMID 29372260

Citations 3

Authors

Hiok Yang Chan

Rehena Sultana

Seng Jin Yeo

Shi-Lu Chia

Hee Nee Pang

Ngai Nung Lo

Affiliations

Soon will be listed here.

Abstract

Introduction: The benefits of extended inpatient rehabilitation following total knee arthroplasty (TKA) in local community hospitals (CHs) are unproven. Our study compared functional outcomes between patients discharged home and to CHs following TKA.

Methods: A case-control study was conducted of patients undergoing primary unilateral TKA. Consecutive patients (n = 1,065) were retrospectively reviewed using the Knee Society Clinical Rating System (KSCRS), 36-item Short Form Health Survey (SF-36) and Oxford Knee Score (OKS) preoperatively, and at the six-month and two-year follow-ups.

Results: Overall, 967 (90.8%) patients were discharged home and 98 (9.2%) to CHs. CH patients were older (mean age 70.7 vs. 67.2 years; p < 0.0001), female (86.7% vs. 77.5%; p = 0.0388) and less educated (primary education and above: 61.7% vs. 73.8%; p = 0.0081). Median CH length of stay was 23.0 (range 17.0-32.0) days. Significant predictors of discharge destination were older age, female gender, lower education, and poorer ambulatory status and physical health. Preoperatively, CH patients had worse KSCRS Function (49.2 ± 19.5 vs. 54.4 ± 16.8; p = 0.0201), SF-36 Physical Functioning (34.3 ± 22.6 vs. 40.4 ± 22.2; p = 0.0017) and Social Functioning (48.2 ± 35.1 vs. 56.0 ± 35.6; p = 0.0447) scores. CH patients had less improvement for all scores at all follow-ups. Regardless of preoperative confounders, with repeated analysis of variance, discharge destination was significantly associated with KSCRS, SF-36 and OKS scores.

Conclusion: Older, female and less educated patients with poorer preoperative functional scores were more likely to be discharged to CHs after TKA. At the two-year follow-up, patients in CHs had less improvement in functional outcomes than those discharged home.

Citing Articles

The Investigation of Preoperative Factors Associated With Postoperative Outcomes Following Total Knee Arthroplasty for Osteoarthritis: A Scoping Review.

Nasu T, Yamanoi J, Kitagawa T Cureus. 2024; 16(7):e64989.

PMID: 39161506 PMC: 11333026. DOI: 10.7759/cureus.64989.

Postoperative Inpatient Rehabilitation Does Not Increase Knee Function after Primary Total Knee Arthroplasty.

Rak D, Nedopil A, Sayre E, Masri B, Rudert M J Pers Med. 2022; 12(11).

PMID: 36422110 PMC: 9697033. DOI: 10.3390/jpm12111934.

Risk Factors for Nonresilient Outcomes in Older Adults After Total Knee Replacement.

Laskow T, Zhu J, Buta B, Oni J, Sieber F, Bandeen-Roche K J Gerontol A Biol Sci Med Sci. 2021; 77(9):1915-1922.

PMID: 34480562 PMC: 9434465. DOI: 10.1093/gerona/glab257.

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