Context.— Inpatient rehabilitation after elective hip and knee arthroplasty is
often necessary for patients who cannot function at home soon after surgery,
but how soon after surgery inpatient rehabilitation can be initiated has not
Objective.— To test the hypothesis that high-risk patients undergoing elective hip
and knee arthroplasty would incur less total cost and experience more rapid
functional improvement if inpatient rehabilitation began on postoperative
day 3 rather than day 7, without adverse consequences to the patients.
Design.— Randomized controlled trial conducted from 1994 to 1996.
Setting.— Tertiary care center.
Participants.— A total of 86 patients undergoing elective hip or knee arthroplasty
and who met the following criteria for being high risk: 70 years of age or
older and living alone, 70 years of age or older with 2 or more comorbid conditions,
or any age with 3 or more comorbid conditions. Of the 86 patients, 71 completed
Interventions.— Random assignment to begin inpatient rehabilitation on postoperative
day 3 vs postoperative day 7.
Main Outcome Measures.— Total length of stay and cost from orthopedic and rehabilitation hospital
admissions, functional performance in hospitals using a subset of the functional
independence measure, and 4-month follow-up assessment using the RAND 36-item
health survey I and the functional status index.
Results.— Patients who completed the study and began inpatient rehabilitation
on postoperative day 3 exhibited shorter mean (±SD) total length of
stay (11.7±2.3 days vs 14.5±1.9, P<.001),
lower mean (±SD) total cost ($25891±$3648 vs $27762±$3626, P<.03), more rapid attainment of short-term functional
milestones between days 6 and 10 (36.2±14.4 m ambulated vs 21.4±13.3
m, P<.001; 4.8±0.8 mean transfer functional
independence measure score vs 4.3±0.7, P<.01),
and equivalent functional outcome at 4-month follow-up.
Conclusion.— These data showed that high-risk individuals were able to tolerate early
intensive rehabilitation, and this intervention yielded faster attainment
of short-term functional milestones in fewer days using less total cost.