PURPOSE OF STUDY. We investigated the effect of weekend knee arthroplasty surgery on length of inpatient stay. METHODS. 341 consecutive patients undergoing primary total knee replacement were retrospectively identified. Of these 62 underwent surgery during the weekend. Length of inpatient stay, age, sex, pre-operative haemoglobin, ASA rating, and day of surgery were recorded. Multiple regression analysis was used to determine the effect of these preoperative factors on length of post-operative inpatient stay. RESULTS. The mean length of stay following primary knee replacement was 5.9 days, with a median 4 days (2-31). Multivariate analysis confirmed that age at operation, sex, pre-operative haemoglobin and ASA were predictive of length of stay following knee arthroplasty. The day of the operation was not predictive of length of post operative stay. DISCUSSION. The results from this study suggest age, sex, ASA and preoperative haemoglobin are predictive of inpatient hospital stay. This is consistent with previous published data. Day of surgery was not predictive of length of stay. Our results suggest that weekend knee arthroplasty surgery does not result in an increased length of inpatient stay

Our aim in this audit was to determine whether intensive rehabilitation post-operatively influenced length of stay and readmission rates for patients undergoing primary total knee arthroplasty. In September 2007, a dedicated weekend physiotherapy service was set up in our Trust for patients following joint arthroplasty at a cost of £30,000 per annum. A prospective audit was conducted over two six-month periods, before and after the introduction of this service, including 202 and 240 patients respectively. Patient demographics including ASA grade and strict inclusion and exclusion criteria were used. The effect of anaesthetic type on post-operative pain control was also reviewed. Chi-squared and Mann-Whitney tests were used to analyse non-parametric data. In the second cohort, with intensive rehabilitation, a statistically significantly higher number of patients were discharged within seven days of admission (64% vs 36%, p<0.01). This was despite there being a significantly higher number of patients with high ASA grades 3-4 in this cohort (37% vs 27%, p<0.05). The median length of stay in the second cohort was seven days compared to eight in the first cohort. There was a slight increase in rate of readmission within the second cohort but this was not statistically significant. We found that the addition of a femoral nerve block significantly reduced post-operative pain. We concluded that an annual financial saving to the Trust of approximately £118,000 could be made by the addition of an additional dedicated physiotherapist in our unit. Patients can be safely discharged sooner with intensive rehabilitation and may benefit in the longer term by improved knee function

Aims

A pragmatic, single-centre, double-blind randomized clinical trial was conducted in a NHS teaching hospital to evaluate whether there is a difference in functional knee scores, quality-of-life outcome assessments, and complications at one-year after intervention between total knee arthroplasty (TKA) and patellofemoral arthroplasty (PFA) in patients with severe isolated patellofemoral arthritis.

In Scotland, the number of primary total knee replacements performed annually has been increasing steadily. The price of the implant is fixed but the length of hospital stay is variable.

We prospectively investigated all patients who underwent primary unilateral total knee replacement in the Scottish region of Fife, between December 1994 and February 2007 and assessed their recorded pre-operative details. The data were analysed using univariate and multiple linear regression statistical analysis.

Data on the length of stay were available from a total of 2106 unilateral total knee replacements. The median length of hospital stay was eight days. The significant pre-operative risk factors for an increased length of stay were the year of admission, details of the consultant looking after the patient, the stair score, the walking-aid score and age.

Awareness of the pre-operative factors which increase the length of hospital stay may provide the opportunity to influence them favourably and to reduce the time in hospital and the associated costs of unilateral total knee replacement.

Early and accurate prediction of hospital length-of-stay (LOS) in patients undergoing knee replacement is important for economic and operational reasons. Few studies have systematically developed a multivariable model to predict LOS. We performed a retrospective cohort study of 1609 patients aged ≥ 50 years who underwent elective, primary total or unicompartmental knee replacements. Pre-operative candidate predictors included patient demographics, knee function, self-reported measures, surgical factors and discharge plans. In order to develop the model, multivariable regression with bootstrap internal validation was used. The median LOS for the sample was four days (interquartile range 4 to 5). Statistically significant predictors of longer stay included older age, greater number of comorbidities, less knee flexion range of movement, frequent feelings of being down and depressed, greater walking aid support required, total (versus unicompartmental) knee replacement, bilateral surgery, low-volume surgeon, absence of carer at home, and expectation to receive step-down care. For ease of use, these ten variables were used to construct a nomogram-based prediction model which showed adequate predictive accuracy (optimism-corrected R² = 0.32) and calibration. If externally validated, a prediction model using easily and routinely obtained pre-operative measures may be used to predict absolute LOS in patients following knee replacement and help to better manage these patients.

Cite this article: Bone Joint J 2013;95-B:1490–6.