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
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.
Method
A series 0f 1509 patients undergoing primary THA or TKA at a private hospital between 2021-2022, under the care of the investigating surgeons who have consented to participation, were identified from our database. The variables include those previously identified as predictive of IPR facility discharge. Multiple regression analysis was used to determine a predictors of discharge to IPR, with odds ratios and corresponding 95%CI.
Results
Of the 722 THA and 776 TKA included, 48.2% THA and 51.8% TKA subjects transferred to IPR post-acutely. Bilateral procedure (OR 7.84 [3.40, 18.03] p<.001), living alone (OR 5.77 [3.37, 9.89] p<.001), older age groups ((66-75 (OR 2.19 [1.39, 3.46] p=.001); (>75 (OR 4.92 [2.70, 9.00] p<.001)), poorer average walking distance preoperatively ((1-2 blocks (OR 1.71 [1.10, 2.65] p=.017); (housebound (OR 2.75 [1.28, 5.89] p=.01)), were significant predictors for the use of IPR following THA. In TKA cohort, the significant predictors for likelihood of IPR facility discharge were female gender (OR 2.47 [1.62, 3.77] p<.001), older age groups ((66-75 (OR 1.72 [1.08, 2.75] p=.023); (>75 (OR 4.23 [2.31, 7.76] p<.001)), bilateral procedure (OR 6.86 [3.53, 13.33] p<.001), being obese (OR 1.76 [1.18, 2.62] p=.006), living alone (OR 2.86 [1.58, 5.16] p=.001) and surgeon ((surgeon C (OR 2.30 [1.11, 4.73] p=.024); (surgeon D (OR 3.04 [1.45, 6.36] p=.003); (surgeon E (OR 2.18 [1.02, 4.69] 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. Whilst some of the predictors may have solid clinical foundation, we have identified other factors in TKA patients that can be targeted, such as female gender, obesity and surgeon, to reduce unnecessary IPR referral in the private sector. This is crucial to sustain the growing demand for TJA which will require a sustainable healthcare resource allocation.