HSS Journal

, Volume 7, Issue 1, pp 16-20

First online:

Initiating Physical Therapy on the Day of Surgery Decreases Length of Stay Without Compromising Functional Outcomes Following Total Hip Arthroplasty

  • Karen JulianoAffiliated withDepartment of Rehabilitation, Hospital for Special Surgery Email author 
  • , Danielle EdwardsAffiliated withDepartment of Rehabilitation, Hospital for Special Surgery
  • , Daniel SpinelloAffiliated withHospital for Special Surgery
  • , Yolanda CapizzanoAffiliated withHunter College
  • , Emie EpelmanAffiliated withHunter College
  • , Jennifer KalowitzAffiliated withHunter College
  • , Adina LempelAffiliated withHunter College
  • , Hassan GhomrawiAffiliated withDivision of Health Policy, Department of Public Health, Weill Cornell Medical CollegeHospital for Special Surgery

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In response to rising health care costs, hospitals are implementing clinical pathways in order to standardize care, improve cost efficiency and outcomes. The purpose of this study was to evaluate the effect of initiating physical therapy (PT) on post operative day 1 (POD1) compared to initiating PT on day of surgery (DOS), on length of stay and in-hospital rehabilitation functional outcomes in total hip arthroplasty patients. This change in PT guidelines was part of the implementation of a new multidisciplinary clinical pathway, adopted by the institution in 2007. A retrospective descriptive study of 408 subjects undergoing unilateral THA compared two groups (204 in each group): those who initiated PT on POD1 and those who initiated PT on DOS. Compared to the POD1 group, patients in the DOS group stayed on average 0.21 days less in the hospital. There was no difference in the achievement of functional milestones in spite of the shortened hospitalization. The initiation of a new clinical pathway was successful in reducing mean length of stay while still allowing patients to achieve all necessary functional outcomes, required for discharge home.


total hip arthroplasty physical therapy rehabilitation outcomes length of stay clinical pathway