Factors affecting length of stay and need for rehabilitation after hip and knee arthroplasty

Forrest, George; Fuchs, Marc D.; Gutierrez, Ariel; Girardy, James

doi:10.1016/s0883-5403(98)90097-3

Cited by 123 publications

(62 citation statements)

References 5 publications

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“…However, we found that in patients aged over 75 there was no significant difference in LOS between the male and female patients. This finding has been supported by a few other studies [24,25]. Interestingly, we also found that in patients over 75, increased comorbidity did not correlate with increased length of stay.…”

Section: Discussionsupporting

confidence: 92%

Factors associated with prolonged length of stay following a total knee replacement in patients aged over 75

Raut

Mertes

Muniz‐Terrera

et al. 2012

International Orthopaedics (SICOT)

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Purpose The aim of this study was to examine factors associated with a prolonged length of stay (LOS) in patients over 75 undergoing a total knee replacement (TKR). Methods Patients over 75 undergoing a TKR at our institution from January 2008 to February 2009 were identified (n0112). Patient and operative factors previously shown to affect length of stay were identified. Patient notes were reviewed for details on each of these and data analysed for their effect on length of stay. Discrete data were analysed for their effect on postoperative length of stay using either the Mann-Whitney U test or the Kruskall-Wallis test and continuous data analysed with the Spearman's rank correlation coefficient. Results The following factors were associated with length of stay at the 95 % confidence level: patient age, pre-operative mobility and the use of walking aids, BMI, whether the patient was able to mobilise within 24 or 48 hours of the surgery, the day on which the patient first walked ten metres and achieved 90°active knee flexion, pre and post-operative haemoglobin and the need for a blood transfusion. Conclusions Pre-operative use of walking aids, perioperative haemoglobin concentration, failure to mobilise early following the operation and post-operative complications (including the need for a blood transfusion) seem to be the significant factors associated with a prolonged stay in hospital in the over 75 year olds.

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Section: Discussionsupporting

confidence: 92%

Factors associated with prolonged length of stay following a total knee replacement in patients aged over 75

Raut

Mertes

Muniz‐Terrera

et al. 2012

International Orthopaedics (SICOT)

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“…Patient expectation of discharge to ECF remained a significant predictor of increased LOS even after controlling for Medicare's 3-day rule to quality for discharge to ECF. We have also confirmed earlier findings, particularly the association between LOS and age [9][10][11][12] and absence of association between LOS and BMI, sex, and comorbidities [10,13,16]. Pain and patient expectations represent compelling targets for intervention to reduce LOS.…”

Section: Discussionsupporting

confidence: 89%

“…Previous studies have identified several factors that influence LOS after primary THA, including age [9][10][11][12], sex [9,10,12], comorbidities [12,13], body mass index [14], surgical approach [15], use of assistive devices [16], functional status [12], general health perception [10,13], and surgeon experience [10]. However, many of those studies had significantly long mean LOS [9,10], excluded patients with diagnoses other than primary osteoarthritis [16], focused only on select comorbidities [12], or required the use of time-consuming scoring systems [10,13].…”

mentioning

confidence: 99%

Preoperative Pain Level and Patient Expectation Predict Hospital Length of Stay After Total Hip Arthroplasty

Halawi

Vovos

Green

et al. 2015

The Journal of Arthroplasty

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a b s t r a c t a r t i c l e i n f oThe purpose of this study was to identify preoperative predictors of length of stay after primary total hip arthroplasty in a patient population reflecting current trends toward shorter hospitalization and using readily obtainable factors that do not require scoring systems. A retrospective review of 112 consecutive patients was performed. High preoperative pain level and patient expectation of discharge to extended care facilities (ECFs) were the only significant multivariable predictors of hospitalization extending beyond 2 days (P = 0.001 and P b 0.001 respectively). Patient expectation remained significant after adjusting for Medicare's 3-day requirement for discharge to ECFs (P b 0.001). The study was adequately powered to analyze the variables in the multivariable logistic regression model, which had a concordance index of 0.857.

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“…The loss of quadriceps strength after TKA has been studied extensively and is a result of a combination of insults, including preexisting quadriceps weakness characteristic of knee OA [11,20,33,40], surgical trauma during TKA [8,37], and age-related limitations in the recovery of muscle function [12,23,45]. One month after surgery, quadriceps strength decreases to 60% of preoperative levels despite initiating postoperative rehabilitation within 24 hours after surgery [26,41].…”

Section: Introductionmentioning

confidence: 99%

Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty

Stevens-Lapsley

Balter

Kohrt

et al. 2010

Clinical Orthopaedics &Amp; Related Research

147

131

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Background/rationale Although TKA reliably reduces pain from knee osteoarthritis, full recovery of muscle strength and physical function to normal levels is rare. We presumed that a better understanding of acute changes in hamstrings and quadriceps muscle performance would allow us to enhance early rehabilitation after TKA and improve long-term function. Questions/purposes The purposes of this study were to (1) evaluate postoperative quadriceps and hamstrings muscle strength loss after TKA and subsequent recovery using the nonoperative legs and healthy control legs for comparison, and (2) measure hamstrings coactivation before and after TKA during a maximal isometric quadriceps muscle contraction and compare with nonoperative and healthy control legs. Methods We prospectively followed 30 patients undergoing TKA at 2 weeks preoperatively and 1, 3, and 6 months postoperatively and compared patient outcomes with a cross-sectional cohort of 15 healthy older adults. Bilateral, isometric strength of the quadriceps and hamstrings was assessed along with EMG measures of hamstrings coactivation during a maximal isometric quadriceps contraction. Results There were no differences in strength loss or recovery between the quadriceps and hamstrings muscles of the operative leg throughout the followup, although differences existed when compared with nonoperative and healthy control legs. Hamstrings muscle coactivation in the operative leg during a maximal quadriceps effort was elevated at 1 month (144.5%) compared to the nonoperative leg. Conclusions Although quadriceps dysfunction after TKA typically is recognized and addressed in postoperative therapy protocols, hamstrings dysfunction also is present and should be addressed. Clinical Relevance Quadriceps and hamstrings muscle strengthening should be the focus of future rehabilitation programs to optimize muscle function and long-term outcomes.

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Factors affecting length of stay and need for rehabilitation after hip and knee arthroplasty

Cited by 123 publications

References 5 publications

Factors associated with prolonged length of stay following a total knee replacement in patients aged over 75

Factors associated with prolonged length of stay following a total knee replacement in patients aged over 75

Preoperative Pain Level and Patient Expectation Predict Hospital Length of Stay After Total Hip Arthroplasty

Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty

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