Predicting discharge destination following total joint arthroplasty (TJA) is important, as discharge destination has major implications for post-operative costs, clinical outcomes, and readmissions. Few studies have looked at factors affecting discharge destination for patients following primary simultaneous bilateral total joint arthroplasty.
The purpose of this study was to describe clinical and social factors that relate to a discharge to home versus rehabilitation facility (RF) for patients after primary simultaneous bilateral total hip arthroplasty (PSBTHA) or primary simultaneous bilateral total knee arthroplasty (PSBTKA).
The inclusion criteria for this retrospective cohort study were all patients after PSBTHA or PSBTKA at a metropolitan orthopedic specialty hospital between February 1, 2016, and March 31, 2018. Exclusion criteria were revisions, differing weight-bearing status, bed-rest orders, and non-standard hip precautions. Social and clinical demographic data were collected. Multiple regression analysis was conducted to determine which factors related most to discharge plan.
Of 253 PSBTHA patients, 153 were discharged home and 100 to an RF. Regression analysis found a posterolateral approach to be the only significant factor associated with an RF discharge. Of 619 PSBTKA patients, 136 were discharged home and 483 to RF. Increased body mass index and older age increased the likelihood of discharge to an RF. Patients with an adductor-only nerve block were more likely to be sent to RF.
These findings shed light on the variables that contribute to discharge destination after PSBTHA and PSBTKA. Such information allows for safe pre-operative discharge planning and assists with discharge to the appropriate level of patient care. Future studies might investigate the effect of surgeon experience, surgical technique, and pre-operative discussion with a physical therapist on the discharge disposition of patients undergoing bilateral total joint arthroplasty.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Akbaba YA, Yeldan I, Guney N, Ozdincler AR. Intensive supervision of rehabilitation programme improves balance and functionality in the short term after bilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016;24(1):26–33.
Fang M, Hume, E, Ibrahim, S. Race, bundled payment policy, and discharge destination after TKA: the experience of an urban academic hospital. Geriatr Orthop Surg Rehabil. 2018;9:1–6.
Fleischman AN, Austin MS, Purtill JJ, Parvizi J, Hozack WJ. Patients living alone can be safely discharged directly home after total joint arthroplasty. J Bone Joint Surg Am. 2018;100(2):99–106.
Fu MC, Samuel AM, Sculco PK, MacLean CH, Padgett DE, McLawhorn AS. Discharge to inpatient facilities after total hip arthroplasty is associated with increased postdischarge morbidity. J Arthroplast. 2017;32(9):S144–S149.
Gholson JJ, Pugely AJ, Bedard NA, Duchman KR, Anthony CA, Callaghan JJ. Can we predict discharge status after total joint arthroplasty? A calculator to predict home discharge. J Arthroplast. 2016;31(12):2705–2709.
Hadley S, Day M, Schwarzkopf R, Smith A, Slover J, Zuckerman J. Is simultaneous bilateral total knee arthroplasty (BTKA) as safe as staged BTKA? Am J Orthop (Belle Mead NJ). 2017;46(4):E224–E229.
Hamel MB, Toth M, Legedza A, Rosen MP. Joint replacement surgery in elderly patients with severe osteoarthritis of the hip or knee: decision making, postoperative recovery, and clinical outcomes. Arch Intern Med. 2008;168(13):1430–1440.
Hansen VJ, Gromov K, Lebrun LM, Rubash HE, Malchau H, Freiberg AA. Does the risk assessment and prediction tool predict discharge disposition after joint replacement? Clin Orthop Relat Res. 2015;473(2):597–601.
Halawi MJ, Vovos TJ, Green CL, Wellman SS, Attarian DE, Bolognesi MP. Patient expectation is the most important predictor of discharge destination after primary total joint arthroplasty. J Arthroplast. 2015;30(4):539–542.
Ishii Y, Noguchi H, Takeda M, Sato J, Suzuki T. Length of hospital stay with patient-dependent determination in bilateral scheduled staged total knee arthroplasty. Eur J Orthop Surg Traumatol. 2014;24(6):961–965.
Jette DU, Stilphen M, Ranganathan VK, Passek SD, Frost FS, Jette AM. AM-PAC “6-Clicks” functional assessment scores predict acute care hospital discharge destination. Phys Ther. 2014;94(9):1252–1261.
Jones DL. A public health perspective on physical activity after total hip or knee arthroplasty for osteoarthritis. Phys Sportsmed. 2011;39(4):70–79.
Karuppiah SV, Banaszkiewicz PA, Ledingham WM. The mortality, morbidity and cost benefits of elective total knee arthroplasty in the nonagenarian population. Int Orthop. 2008;32(3):339–343.
Keswani A, Tasi MC, Fields A, Lovy AJ, Moucha CS, Bozic KJ. Discharge destination after total joint arthroplasty: an analysis of postdischarge outcomes, placement risk factors, and recent trends. J Arthroplast. 2016;31(6):1155–1162.
Keswani A, Weiser MC, Shin J, Lovy AJ, Moucha CS. Discharge destination after revision total joint arthroplasty: an analysis of postdischarge outcomes and placement risk factors. J Arthroplast. 2016;31(9):1866–1872.
London DA, Vilensky S, O’Rourke C, Schill M, Woicehovich L, Froimson MI. Discharge disposition after joint replacement and the potential for cost savings: effect of hospital policies and surgeons. J Arthroplast. 2016;31(4:743–748.
Martin CT, Pugely AJ, Gao Y, Clark CR. A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplast. 2013;28(5):849–854.
Menendez ME, Schumacher CS, Ring D, Friberg AA, Rubash HE, Kwon YM. Does “6-Clicks” day 1 postoperative mobility score predict discharge disposition after total hip and knee arthroplasties? J Arthroplast. 2016;31(9):1916–1920.
Muskus M, Roja J, Gutierrez C, Guio J, Bonilla G, Llinás A. (2018). Bilateral hip arthroplasty: when is it safe to operate the second hip? A systematic review. Biomed Res Int. 2018;3150349. doi: https://doi.org/10.1155/2018/3150349
Padgett DE, Christ AB, Joseph A, Lee YY, Haas SB, Lyman S. Discharge to inpatient rehab does not result in improved functional outcomes following primary total knee arthroplasty. J Arthroplast. 2018;33(6):1663–1667.
Phillips LH, Rondon AJ, Gorica Z, Fillingham YA, Austin MS, Courtney PM. No difference in total episode-of-care cost between staged and simultaneous bilateral total joint arthroplasty. J Arthroplast. 2018;33(12):3607–3611.
Salvat E, Hughes P, Lachiewicz P. Bilateral total hip-replacement arthroplasty in one stage. J Bone Joint Surg Am. 1978;60(5):640–644.
Shao H, Chen, CL, Maltenfort MG, Restrepo C, Rothman RH, Chen AF. Bilateral Total hip arthroplasty: 1-stage or 2-stage? A meta-analysis. J Arthroplast. 2017;32(2):689–695.
Sher A, Keswani A, Yao DH, Anderson M, Koenig K, Moucha CS. Predictors of same-day discharge in primary total joint arthroplasty patients and risk factors for post-discharge complications. J Arthroplast. 2017;32(9S):S150–S156.
Sobh AH, Siljander MP, Mells AJ, Koueiter DM, Moore DD, Karadsheh MS. Cost analysis, complications, and discharge disposition associated with simultaneous vs staged bilateral total knee arthroplasty. J Arthroplast. 2018;33(2):320–323.
Tarity TD, Swall MM. Current trends in discharge disposition and post-discharge care after total joint arthroplasty. Curr Rev Musculoskelet Med. 2017;10(3):397–403.
Tayrose G, Newman D, Slover J, Jaffe F, Hunter T, Bosco J. Rapid mobilization decreases length-of-stay in joint replacement patients. Bull Hosp Jt Dis. 2013;71(3):222–226.
Tiwari V, Park CK, Lee SW, Kim MJ, Seong JS, Kim TK. Does discharge destination matter after total knee arthroplasty? A single-institution Korean experience. Knee Surg Rel Res. 2018;30(3):215–224.
Vaishya R, Vijay V, Mani KCK, Agarwal AK. Is simultaneous bilateral total knee arthroplasty safe in geriatric population? A retrospective cohort study with up to 9 years follow up. J Clin Orthop Trauma. 2018;9(2):107–111.
Vissers MM, Bussmann JB, de Groot IB, Verhaar JA, Reijman M. Physical functioning four years after total hip and knee arthroplasty. Gait Posture. 2013;38(2):310–315.
Vulcano E, Memtsoudis S, Della Valle AG. Bilateral total knee arthroplasty guidelines: are we there yet? J Knee Surg. 2013;26(04):273–280.
Watts CD, Houdek M, Wyles CC, Sierra R, Trousdale T, Taunton M. Direct anterior versus posterior simultaneous bilateral total hip arthroplasties: no major differences at 90 days. Am J Orthop (Belle Mead NJ). 2016;45(6):E373–E378.
Conflict of Interest
Danielle Edwards, PT, DPT, Allison Anderson, PT, DPT, Michael R. Pleus, PT, DPT, and Jerome B. Smith, PT, DPT, declare that they have no conflicts of interest. Joseph T. Nguyen, MPH, was supported in part by funds from the Clinical Translational Science Center (CTSC), National Center for Advancing Translational Sciences (NCATS) grant #UL1-RR024996. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCATS, based in Rockville, MD.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.
Informed consent was waived from all patients for being included in this study.
Required Author Forms
Disclosure forms provided by the authors are available with the online version of this article.
Level of Evidence: Level III: Retrospective Cohort Study.
About this article
Cite this article
Edwards, D., Anderson, A., Pleus, M.R. et al. Factors Affecting Discharge Disposition After Primary Simultaneous Bilateral Joint Arthroplasty. HSS Jrnl 15, 254–260 (2019). https://doi.org/10.1007/s11420-019-09701-2
- bilateral hip arthroplasty
- bilateral knee arthroplasty
- bilateral total joint arthroplasty discharge factors