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


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.

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Corresponding author

Correspondence to Karen Juliano PT.

Additional information

Yolanda Capizzano, DPT, Adina Lempel, DPT, Emie Epelman, DPT, and Jennifer Kalowitz, DPT completed this study as students at Hunter College.

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patient/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. There was no financial support for conducting this study.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research. Informed consent was waived by the institutional review board at Hospital for Special Surgery

Level of Evidence: Level III Therapeutic Study: see author instructions for a complete description of levels of evidence.

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Juliano, K., Edwards, D., Spinello, D. et al. Initiating Physical Therapy on the Day of Surgery Decreases Length of Stay Without Compromising Functional Outcomes Following Total Hip Arthroplasty. HSS Jrnl 7, 16–20 (2011).

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