Short-Term Patterns of Recovery from Total Hip and Knee Arthroplasty after Multidisciplinary Inpatient Rehabilitation

Abstract

BACKGROUND: Multidisciplinary inpatient rehabilitation is usual care in Germany after total hip (THA) or knee (TKA) arthroplasty. Some authors argued that the outcome of rehabilitation after THA was ever better as compared with the similar care after TKA or the TKA patients recovered much later. The aim of the study was to compare short-term patterns of recovery in patients undergoing multidisciplinary inpatient rehabilitation after total hip and knee arthroplasty in terms of their health-related quality of life and functional status. DESIGN: Prospective observational study comparing the outcomes of inpatient rehabilitation in 40 consecutive subjects (mean age 65.4 years) following total hip arthroplasty and 41 consecutive subjects (mean age 68.7 years) following total knee arthroplasty, all from a single inpatient rehabilitation facility. The primary outcome measures were SF-36, WOMAC and EQ-5D which were self-administered on admission, at discharge and 3 months after discharge. Longitudinal changes as well as group differences for every points of assessment were computed. RESULTS: Positive longitudinal changes with moderate to large effect sizes were observed for all outcome measures in both groups. The reached effect sizes were greater in WOMAC than in SF-36 and EQ-5D. However, by comparable utilisation of resources the THA patients performed better at the time of discharge. The gap sustained at follow-up resulting in significant differences in favour of the THA group. DISCUSSION: The samples were too small to allow generalisation of the results. Many other co-variables as BMI, co-morbidities and weight bearing could have confounded results. These seem to be in concordance with the literature showing better outcomes in the THA group at discharge as compared with the TKA group. The sensitivity-to-change of the used instruments was better as expected in the short run. CONCLUSION: THA and TKA represent two different states in terms of functional health. Therefore, flexibility in postoperative treatment and rehabilitation is required to achieve comparable functional outcomes. Further research is needed to investigate whether different timing, more intensive therapy, or different rehabilitation strategies would lead to a comparable level of functional health in both groups.