26 November, 2017

Joint Replacement: After Hospital Discharge

There are multiple large scale, published studies that demonstrate that discharge directly home after hip or knee surgery yields the best recovery.

A frequent dilemma for patients coming for a hip or knee replacement is whether or not to go to an inpatient rehabilitation hospital after discharge. Often, patients and their family feel that further inpatient management and "strict" rehabilitation as an inpatient would yield better results. Furthermore, patients and their family are often worried whether it would be safe for the patient to return home after 2 or 3 days in hospital.

This issue has been investigated by clinical medical researchers. A large study from Mt Sinai Hospital in New York, with collaboration from major universities from Texas and New Hampshire, involving over 100,000 patients, found that patients who go home tend to recover better with a far lower rate of complications or problems (The Journal of Arthroplasty: Volume 31, Issue 6, June 2016, Pages 1155-1162). They were far less likely to require readmission to hospital in the first 30 days after discharge.

Another study from the Hospital for Special Surgery in New York, again reviewing over 100,000 patients (this time, only knee replacements), showed higher complications at 30 days after surgery in patients who went to inpatient rehab (The Journal of Arthroplasty:
Volume 32, Issue 9, Supplement, September 2017, Pages S113-S118)

A study from Denmark found that patients over 85 yo can go home safely 3 days after hip or knee replacement surgery - Anesthesia & Analgesia: June 2016 - Volume 122 - Issue 6 - p 1807–1815. They looked at over 500 patients aged over 85 years of age.

It is also important to note that when in rehab, your management is taken over by a different team to that of the surgical team.

These studies unequivocally show that discharge home after surgery is safer than being discharged to an inpatient facility. Therefore, in preparation for your joint replacement, I strongly recommend that you discuss this with your family. Ideally, you could plan to be in hospital for 2 or 3 days and then go home. If there are any concerns, then a family member can plan to stay with you for a few days.

Please feel free to discuss with Pam (practice nurse).

Posted by Shay Zayontz

Shay Zayontz

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