Enhanced recovery in usual health care improves functional recovery after total knee arthroplasty

Background: The success of total knee arthroplasty (TKA) is determined by an effective surgical procedure as well as a well-organized clinical care pathway. Research has shown that day-of-surgery mobilization decreases length of stay (LOS) and complication rates. We developed, implemented, and evaluated a new clinical care pathway for patients undergoing TKA, that included early mobilization, using 'Lean Six Sigma (LSS)', with the aim of accelerating functional recovery and reducing LOS.

Methods: Data derived from physical therapy reports and LOS were compared between the old (n=85) and the new (n=85) clinical care pathways for time to functional recovery (using the modified Iowa Level of Assistance Scale), LOS and joint-related readmission. Group differences were evaluated using Mann-Whitney and Chi-Square tests. The clinical care pathway was redesigned using LSS-methods.

Results: After implementation of the new pathway, median time to functional recovery improved from 4 (2-5) to 2 days (1-8)(P <0.001) and LOS from 7 (5-11) to 4 days (3-12)(P <0.001), joint-related readmission declined (3.5-2.4%)(P=0.65).

Conclusion: Implementation of the new clinical care pathway accelerated functional recovery and reduced LOS for patients undergoing TKA. Future research should focus on having multiple discharge moments per day which might encourage patients to achieve functional recovery as soon as possible.