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

Abstract

Inpatient rehabilitation (IR) is a common postoperative protocol after total knee replacement (TKA). Because IR is expensive and should therefore be justified, this study determined the difference in knee function one year after TKA in patients treated with IR or outpatient rehabilitation, fast-track rehabilitation (FTR) in particular, which also entails a reduced hospital length of stay. A total of 205 patients were included in this multi-center prospective cohort study. Of the patients, 104 had primary TKA at a German university hospital and received IR, while 101 had primary TKA at a Canadian university hospital and received FTR. Patients receiving IR or FTR were matched by pre-operative demographics and knee function. Oxford Knee Score (OKS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and EuroQol visual analogue scale (EQ-VAS) determined knee function one year after surgery. Patients receiving IR had a 2.8-point lower improvement in OKS (p = 0.001), a 6.7-point lower improvement in WOMAC (p = 0.063), and a 12.3-point higher improvement in EQ-VAS (p = 0.281) than patients receiving FTR. IR does not provide long-term benefits to patient recovery after primary uncomplicated TKA under the current rehabilitation regime.

Keywords: fast track rehabilitation; inpatient rehabilitation; patient reported outcome measures; postoperative rehabilitation; total knee arthroplasty.

Figure 1

Improvement in clinical outcome. OKS, Oxford Knee Score; WOMAC, Western Ontario and McMaster Universities Arthritis Index; EQ-VAS, EuroQol visual analogue scale; FTR, fast-track rehabilitation; IR, inhouse rehabiliation; p-values for clinical improvements are from multivariable models; improvements in WOMAC are shown in the positive direction for comparison.