2025 ISAKOS Biennial Congress In-Person Poster
Predictors of Discharge to Inpatient Rehabilitation Following Primary Total Hip and Knee Arthroplasty: Cohort Study
Kaka Martina, RN- PhD Candidate, Wollstonecraft, NSW AUSTRALIA
Lucy J. Salmon, PhD, Sydney, NSW AUSTRALIA
Justin P. Roe, MB BS BSc(Med) Hons, A/Prof., Lindfield, NSW AUSTRALIA
Michael Dudley O'Sullivan, MBBS FRACS FAOrth, Wollstonecraft, NSW AUSTRALIA
Matt Lyons, FRACS, Mosman, NSW AUSTRALIA
Benjamin Robert Gooden, MBBS, FRACS, PhD, Sydney, NSW AUSTRALIA
Leo A. Pinczewski, MBBS, FRACS, FAOA, Sydney, NSW AUSTRALIA
Phil Huang, FRACS, FAOrthA, BEng, MPhil CANTAB, Cremorne Point, NSW AUSTRALIA
David Carmody, MBBS FRACS, Sydney, NSW AUSTRALIA
Keran Sundaraj, MBBS MCs (Trauma) FRACS FAOA, Wollstonecraft, NSW AUSTRALIA
David Hunter, MBBS, MSc (Clin Epi), M SpMed, PhD, FRACP (Rheum)1, St Leonards, New South Wales AUSTRALIA
Michelle Dowsey, PhD, Fitzroy, Victoria AUSTRALIA
North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, New South Wales, AUSTRALIA
FDA Status Not Applicable
Summary
A study to determine prevalence of inpatient rehabilitation (IPR) use in Australian private TJA cohort and predictors of IPR facility discharge following TJA.
Abstract
Aim
The use of inpatient rehabilitation (IPR) following total hip arthroplasty (THA) and total knee arthroplasty (TKA) constitutes the substantial cost of total joint arthroplasty (TJA). This study aims to identify the prevalence of IPR use in Australian private TJA cohort and predictors of IPR facility discharge following TJA, including components of the Risk Assessment and Prediction Tool (RAPT).
Method
Patients who have undergone primary THA and TKA at a single private hospital in Sydney, Australia between 2021 and 2022, under the care of the investigating surgeons with research consent, were identified from our arthroplasty database. The variables assessed in this study include multiple variables previously deemed as predictive factors to IPR facility discharge in the literature and components of RAPT. Multiple regression analysis was used to identify predictors of discharge destination.
Results
Of the 733 THA and 776 TKA included, 46% THA and 64% TKA subjects transferred to IPR post-acutely. Bilateral procedure (OR 7.91 , p<.001), living alone (OR 5.23, p<.001), older age groups ((66-75 (OR 2.14, p=.001); (>75 (OR 5.02, p<.001)), poorer walking distance ((1-2 blocks (OR 1.64, p=.023); (housebound (OR 2.68, p=0.009)), were significant predictors for the use of IPR following THA. In TKA cohort, the significant predictors for IPR discharge were female (OR 2.47, p<.001), older age groups ((66-75 (OR 1.73, p=.021); (>75 (OR 4.23, p<.001)), bilateral procedure (OR 6.86 ,p<.001), being obese (OR 1.76, p=.006), living alone (OR 2.86, p=.001) and surgeon ((surgeon 3 (OR 2.30, p=.024); (surgeon 4 (OR 3.04, p=.003); (surgeon 5 (OR 2.18, p=.046)).
Conclusion
The use of IPR following TJA accounts for significant healthcare expenditures globally. The results of this study highlight preoperative predictors of IPR discharge following THA and TKA. The use of IPR following TJA in this cohort was associated with some clinically justifiable factors, such as bilateral procedure older age and living alone. However, other variables may be driven by inappropriate and potentially modifiable societal expectations, such as female, obesity, surgeon and limited walking distance.