title: A comprehensive joint replacement program for total knee arthroplasty: a descriptive study.
abstract: BACKGROUND
  Total knee arthroplasty (TKA) is a commonly performed surgical procedure in the US. It is important to have a comprehensive inpatient TKA program which maximizes outcomes while minimizing adverse events. The purpose of this study was to describe a TKA program - the Joint Replacement Program (JRP) - and report post-surgical outcomes.
  
  
  METHODS
  74 candidates for a primary TKA were enrolled in the JRP. The JRP was designed to minimize complications and optimize patient-centered outcomes using a team approach including the patient, patient's family, and a multidisciplinary team of health professionals. The JRP consisted of a pre-operative class, standard pathways for medical care, comprehensive peri-operative pain management, aggressive physical therapy (PT), and proactive discharge planning. Measures included functional tests, knee range of motion (ROM), and medical record abstraction of patient demographics, length of stay, discharge disposition, and complications over a 6-month follow-up period.
  
  
  RESULTS
  All patients achieved medical criteria for hospital discharge. The patients achieved the knee flexion ROM goal of 90 degrees (91.7 +/- 5.4 degrees ), but did not achieve the knee extension ROM goal of 0 degrees (2.4 +/- 2.6 degrees ). The length of hospital stay was two days for 53% of the patients, with 39% and 7% discharged in three and four days, respectively. All but three patients were discharged home with functional independence. 68% of these received outpatient physical therapy compared with 32% who received home physical therapy immediately after discharge. Two patients (< 3%) had medical complications during the inpatient hospital stay, and 9 patients (12%) had complications during the 6-month follow-up period.
  
  
  CONCLUSIONS
  The comprehensive JRP for TKA was associated with satisfactory clinical outcomes, short lengths of stay, a high percentage of patients discharged home with outpatient PT, and minimal complications. This JRP may represent an efficient, effective and safe protocol for providing care after a TKA.
authors.affiliation: Department of Rehabilitation Sciences, Verde Valley Medical Center, 269 S. Candy Lane, Cottonwood, AZ, USA. jc15466@nahealth.com
authors.forename: Jon R
authors.initials: JR
authors.lastname: Cook
authors.forename: Meghan
authors.initials: M
authors.lastname: Warren
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Ganley
authors.forename: Paul
authors.initials: P
authors.lastname: Prefontaine
authors.forename: Jack W
authors.initials: JW
authors.lastname: Wylie
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000193:education / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010146:Pain / Q000517:prevention & control; D059408:Pain Management; D010351:Patient Discharge; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D012680:Sensitivity and Specificity; D014481:United States