Is Physical Therapy Clearance Before Arthroplasty Home Discharge Necessary?

Recruiting now · Not applicable

Conditions studied: Physical Therapy, Total Joint Arthroplasty, Same-day Discharge

In brief

Conventionally, physical therapy (PT) clearance is sought before total joint arthroplasty (TJA) discharge. However, PT staffing limitations may preclude same-day discharge in patients having surgery late in the day. Failed same-day discharge in eligible TJA patients results in unnecessary hospital bed occupancy, which increases costs, limits operating room throughput for patients requiring inpatient admission, and introduces risks associated with longer length-of-stay. In collaboration with an institutional PT department, the investigators developed a protocol for discharging same-day TJA patients without postoperative PT clearance. Immediately preoperatively, PT administers gait training. Patients are then discharged home after ambulating with post-anesthesia care unit (PACU) nurses trained by PT on postoperative mobilization. This allows for the maximum number of patients discharged home, including the last patient of the day, PT staffing limitations notwithstanding. Single-institution pilot data demonstrates no increased risk of falls, emergency room (ER) visits, or readmissions with this process. The investigators propose a prospective, controlled, multicenter study to expand on pilot data. The study aim is to assess safety of day-of-surgery preoperative PT and postoperative ambulation with PACU nursing before TJA discharge. The primary endpoint is postoperative falls, while secondary endpoints include 90-day ER visits, 90-day hospital readmissions, patient-reported outcome measures, and patient satisfaction scores.

Key facts

Study ID

NCT05858086

Run by

University of Maryland, Baltimore

People needed

210

Starts

2024-09-27

Expected to finish

2027-12-01

Last updated by the study team

2026-02-10

Who can join

Age: 18 and older, up to 90. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• are 18 years of age or older
• undergo primary THA or TKA
• are eligible for same-day home discharge (friends or family available to stay at home with the patient for one week postoperatively and medically stable for discharge from PACU per anesthesia).

You may not qualify if…

• 90 years of age or older
• have sleep apnea (not eligible for same-day discharge)
• require overnight stay for any reason
• undergo revision THA or TKA.

Where it is running

• University of Maryland — Baltimore, Maryland, United States (enrolling)
• Hospital for Special Surgery — New York, New York, United States

Full record on ClinicalTrials.gov

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