Performance milestones in postoperative physical therapy after total hip arthroplasty: impact on length of stay and discharge destination

Abstract

Background: Early postoperative physical therapy (PT) regimens after total hip arthroplasty (THA) have become the standard of care at most institutions. Initiating PT on postoperative day (POD) 0 after THA has been shown to shorten hospital length of stay (LOS). However, objective performance milestones for early therapy are not well established. Methods: This study retrospectively reviewed 277 patients who underwent primary THA. Specific data assessed included demographic information, number of feet walked at the POD 0 and POD 1 PT evaluations, LOS, and discharge destination. The primary outcome assessed was the relationship between performance in PT with both LOS and discharge destination. For those patients who could not participate in therapy, reasons cited by therapy documentation were recorded. Results: Patients who received POD 0 PT had a shorter LOS (P=0.032), decreased discharge to extended care facility (ECF) (P<0.001), and walked farther in PT on POD 1 (P<0.001). Ambulating farther than 10 feet on POD 0 or 100 feet on POD 1 resulted in significant decreases in LOS (P=0.005, P<0.001) and in the percentage of patients discharged to an ECF (P=0.027, P<0.001). The most common reason for inability to participate in therapy was late arrival to the inpatient floor. Conclusions: Achieving mobility milestones is a key factor in the determination of a patient’s discharge timing and destination after THA. Limited data exist validating objective performance milestones for patients receiving early PT after THA. This study suggests that achieving mobility milestones on POD 0 and 1 can significantly improve short-term outcomes.