James Randolph Onggo1, Jason Derry Onggo1, Richard De Steiger2, Raphael Hau3. 1. Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia. 2. Department of Surgery Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia. 3. Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia; Department of Orthopaedic Surgery, Northern Hospital, Melbourne, Victoria, Australia.
Abstract
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.
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.