For people considering hip or knee replacement surgery, it’s something they want — and need — to know.
In the US alone, surgeons perform more than 600,000 knee replacements and about 330,000 hip replacements each year. These operations can provide a major improvement in quality of life and function for those with severe arthritis. On the other hand, there are risks associated with the operation (as is true for any major surgery), there is a long road to recovery even when all goes well, and these operations aren’t cheap. For knee replacement surgery alone, an estimated $9 billion or more is spent each year in the US (although economic analyses suggest the surgery may actually be cost-saving over the long run).
So, if the first joint replacement is unsuccessful for some reason (such as infection or loosening), a second (or even third) operation may be necessary. And that’s a big deal, especially since “revision surgery” is technically more difficult, recovery can take longer, and success rates may be lower than first operations.
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 patients 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.
Hip and knee replacement surgery—which is nearly always partnered with rehabilitation including physical therapy—is the target of a proposed Medicare test of a bundled payment model, which will hold acute-care hospitals in 75 areas around the US accountable for their costs and quality of care. It’s yet another signal that health care reform is moving away from fee-for-service payment models and toward paying for value and outcomes.
The chosen areas include Los Angeles and New York City as well as smaller markets, and would affect more than 800 acute-care hospitals. Unlike similar tests of the past, there’s no voluntary sign-up; all facilities must participate.
The 5-year test period would begin January 1, 2016, and end December 31, 2020. Participating hospitals would bear the financial risk of the episode of care, which would begin at admission to the hospital and end 90 days after discharge, to include all related care covered under Medicare Parts A and B—the procedure, inpatient stay, hospital care, postacute care, and provider services.