Impact of Perioperative Care Transitions on In-Hospital Recovery After Total Knee Arthroplasty: A Data-Driven 11-Year Study

Daniel Strijbos, Jelmer Jager, Nico van Meeteren, Geert van der Sluis, Wim van Houtert, Richard Bimmel, Wim Krijnen
Purpose:

To evaluate the effectiveness of stepwise improvements in perioperative care—ranging from baseline Joint Care to Function-tailored care, Fast-track recovery, and Prehabilitation—on in-hospital recovery metrics including time to inpatient recovery of activities (IROA), length of stay (LOS), and discharge to preoperative living situation (PLS).

Methods:

This observational cohort study analyzed electronic health records of 1,853 patients who received primary TKA between 2009 and 2020. Patients were divided into four periods corresponding to the care transitions: Joint Care, Function-tailored care, Fast-track recovery, and Prehabilitation. The primary outcomes were IROA (measured with the modified Iowa Level of Assistance Scale), LOS, and discharge to PLS. Multivariable regression models adjusted for patient characteristics such as age, BMI, ASA grade, ISAR score, TUG time, and DEMMI score were used to evaluate the impact of each care transition.

Results:

The study found significant improvements in IROA, LOS, and discharge to PLS with each care transition. IROA decreased from a mean of 4.4 days during Joint Care to 2.5 days (SD 1.0; p 0.001) during the Prehabilitation period. Similarly, LOS reduced from 5.2 days to 2.9 days (SD 1.6; p 0.001), and the proportion of patients discharged to PLS increased from 69% to 92.6% (p 0.001). Each transition period significantly improved IROA, and the positive effect on discharge to PLS.

Conclusion(s):

This study demonstrates the substantial benefits of systematically improving perioperative care for TKA patients. The observed reductions in IROA and LOS, alongside increased rates of discharge to PLS, suggest that targeted perioperative care strategies, including prehabilitation, can significantly enhance recovery outcomes. These findings advocate for the continued refinement of perioperative pathways to optimize patient outcomes post-TKA.

Implications:

Healthcare providers, and especially hospital-based physiotherapists, should consider adopting and further refining perioperative care strategies such as Fast-track and Prehabilitation programs to enhance patient recovery and reduce hospital resource utilization.

Funding acknowledgements:
No financial or material support was received for this study.
Keywords:
Total Knee Arthroplasty
Perioperative Care
Prehabilitation
Primary topic:
Orthopaedics
Second topic:
Musculoskeletal: lower limb
Third topic:
Disability and rehabilitation
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Ethical approval was obtained from Nij Smellinghe Hospital’s Medical Ethical Committee,
Provide the ethics approval number:
reference ID: 16-107/JS/AB, 3 December 2013.
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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