Patients who live alone can safely be sent home after joint replacement

January 19, 2018, Wolters Kluwer Health

Most patients who live alone can be safely discharged home from the hospital to recover after hip or knee replacement surgery, suggests a study in the January 17, 2018 issue of The Journal of Bone & Joint Surgery.

The results question the belief that who live alone should routinely be sent to an inpatient rehabilitation facility after total joint replacement surgery, before going home. "Patients living alone had a safe and manageable recovery when discharged directly home after total joint arthroplasty," write Andrew N. Fleischman, MD, and colleagues from The Rothman Institute, Thomas Jefferson University, Philadelphia.

Similar Outcomes after Joint Replacement for Patients Living Alone

The study included 769 patients who were discharged home after one-sided total hip or knee replacement. Of these, 138 patients were living alone for the first two weeks after surgery. The researchers compared complication rates and other important outcomes for patients who lived alone versus those who lived with others.

Average age (about 66 years for patients living alone and 65 for those living with others) and other preoperative characteristics were similar between groups. About 37 percent of patients living alone said that they did not have daily or even weekly visitors. However, 79 percent had someone within 15 minutes away if needed.

Patients who lived alone were more likely than those not living alone to spend more than one night in the hospital: about 21 versus seven percent after hip replacement and 59 versus 28 percent after knee replacement. Patients living alone also had higher rates of in-home nursing care and physical therapy.

Otherwise, outcomes were similar for patients living alone compared to those who lived with others. In both groups, the overall post-discharge complication rate was about eight percent. The two groups also had similar rates of "unplanned clinical events," such as emergency department or urgent care visits. Pain relief and satisfaction scores during recovery were similar as well.

Up to six months after surgery, there were no significant differences in scores for joint functioning and quality of life. Nearly 90 percent of patients living alone said they would choose to be discharged home again. However, patients living alone did report more problems attending to personal hygiene.

"Despite the expense and potential hazards of inpatient rehabilitation, there is a prevailing belief that patients living alone cannot be safely discharged directly home after total joint arthroplasty," Dr. Fleischman and coauthors write. According to a report by the US Department of Health and Human Services Office of Inspector General, one-third of Medicare patients have adverse or harmful events while at an inpatient rehabilitation or skilled nursing facility.

Although some patients who live alone can benefit from home health services or even an extra day in the hospital, discharge directly home may be much more economical than routinely sending them for inpatient rehabilitation—while also avoiding the associated risks. Dr. Fleischman and colleagues conclude: "This prospective study provided evidence to support the safety and efficacy of direct home discharge after total joint arthroplasty for the large majority of patients living alone, justifying this practice as a reasonable standard of routine care."

Explore further: Home may be the best place to recover after total joint replacement surgery

More information: Andrew N. Fleischman et al. Patients Living Alone Can Be Safely Discharged Directly Home After Total Joint Arthroplasty, The Journal of Bone and Joint Surgery (2018). DOI: 10.2106/JBJS.17.00067

Related Stories

Home may be the best place to recover after total joint replacement surgery

March 14, 2017
Despite higher costs, many doctors recommend and some patients prefer, recovery at an in-patient rehabilitation facility following total hip (THR) or total knee replacement (TKR) surgery. And yet a new study to be presented ...

Small increases in complications when knee replacement done as outpatient procedure

December 13, 2017
Some complications are more common when total knee replacement surgery is done as an outpatient or same-day procedure, reports a study in the December 6, 2017 issue of The Journal of Bone & Joint Surgery.

Compared to home-based program, in-patient rehab following knee replacement does not improve mobility

March 14, 2017
Among patients with osteoarthritis undergoing total knee replacement and who have not experienced a significant early complication, the use of inpatient rehabilitation compared with a monitored home-based program did not ...

Patients going home after knee replacement do as well as those going to rehab facility

March 24, 2015
A study by researchers at Hospital for Special Surgery (HSS) finds that patients who go home after knee replacement and receive physical therapy at home do as well as those discharged to an in-patient rehabilitation facility.

For stroke patients, rating scales predict discharge destination

December 18, 2017
Stroke survivors with higher scores on widely used outcome measures are more likely to be discharged home from the hospital, while those with lower scores are more likely to go to a rehabilitation or nursing care facility, ...

Can physical therapy before hip or knee replacement surgery improve outcomes?

October 7, 2014
Physical therapy after total hip (THR) or total knee replacement (TKR) surgery is standard care for all patients. A new study, appearing in the October 1 issue of the Journal of Bone & Joint Surgery (JBJS), also found that ...

Recommended for you

Surprise finding—for very sick elderly, lighter sedation won't drop risk of postoperative delirium, study suggests

August 13, 2018
Johns Hopkins Medicine researchers say a study designed to see if reducing the amount of anesthesia reduces the risk of postoperative delirium in older patients surprisingly found that lighter sedation failed to do so in ...

Kidney transplant chains more effective in saving lives

August 9, 2018
New research from the UBC Sauder School of the Business has found that transplant societies which prioritize kidney transplant chains over kidney exchanges can increase the total number of transplants, thereby saving more ...

Surgical mesh implants may cause autoimmune disorders

July 31, 2018
Surgical mesh implants, often used for hernia or gynecological repair, may be the reason so many patients report symptoms of an autoimmune disorder, according to a University of Alberta rheumatologist.

Surgeons discuss options when the risks of surgery may be too high

July 27, 2018
In an essay published July 26 in the New England Journal of Medicine, Ira Leeds, M.D., research fellow, and David Efron, M.D., professor of surgery, both of the Johns Hopkins University School of Medicine, along with their ...

Blood plasma during emergency air transport saves lives

July 25, 2018
Two units of plasma given in a medical helicopter on the way to the hospital could increase the odds of survival by 10 percent for traumatically injured patients with severe bleeding, according to the results of a national ...

The dark side of antibiotic ciprofloxacin

July 25, 2018
The use of ciprofloxacin and other antibiotics of the class of fluoroquinolones may be associated with disruption of the normal functions of connective tissue, including tendon rupture, tendonitis and retinal detachment. ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.