VARIABILITY IN THE ATTAINMENT OF FUNCTIONAL MILESTONES DURING THE ACUTE-CARE ADMISSION AFTER TOTAL JOINT REPLACEMENT

Objective, To quantify patients' functional improvement in the immedia te postoperative period after total hip arthroplasty (THA) or total kn ee arthroplasty (TKA). Methods. A prospective observational study desi gn was used to examine the number of physical therapy treatment sessio ns and postoperative days required to attain independence in 4 critica l functional milestones, with independence defined as the ability to p erform the activity without the assistance of another person. The 4 fu nctional milestones selected were the ability to perform supine to sit transfers; sit:to stand transfers; ambulation to 100'; and the abilit y to climb stairs. Consecutive patients undergoing elective THA or TKA or the first time at a community teaching hospital were entered into the study. Results, The study group consisted of 81 patients undergoin g elective THA or TKA (33 THA and 48 TKA). There was wide variability in the number of physical therapy sessions and postoperative days requ ired to attain each of:the 4 milestones and all 4 milestones. Climbing stairs was the most difficult task, followed by walking 100', perform ing sit to stand transfers, and performing supine to sit transfers. Th e achievement of the latter 2 milestones was similar. Conclusion, Our examination of patients' progress in attaining specific functional mil estones is a unique approach to outcome assessment that emphasizes the physical therapy aspect of postsurgical rehabilitation. A wide variab ility in patients' functional progress during the acute care admission after elective TKA or TKA was demonstrated. The reasons for this vari ability need to be explored since they may have important implications for planning rehabilitation related to THA, TKA or other orthopedic r econstructive procedures.