Inpatient rehab after knee surgery called out as costly

Patients with private health insurance might feel entitled to inpatient rehabilitation following total knee arthroplasty but it offers no benefit over being discharged directly to home.

An Australian study of 129 matched pairs of privately insured patients undergoing a primary, unilateral knee arthroplasty found no difference in patient-reported knee pain or function at three months or 12-months after surgery.

Return to work was not significantly different between the groups while patient perception of overall health at day 35 was worse in the patients receiving inpatient rehabilitation.

Inpatient rehabilitation was significantly more expensive than no inpatient rehabilitation at a median cost of $9,978 versus $374. Even when excluding the inpatient component of care, patients who had received inpatient care had higher costs such as more community physiotherapy visits.

The study excluded patients referred to inpatient rehabilitation because of slow progress or significant complications.

Co-author Associate Professor Justine Naylor from the South Western Sydney Clinical School at the University of NSW, said clinicians should be making their patients aware of the lack of efficacy for inpatient rehabilitation.

“If you are thinking people are needing joint replacement surgery then part of that conversation should be the recovery from that surgery and the rehabilitation from that surgery.”

“It’s up to us to say ‘You are entitled to the rehabilitation pathway that you choose but be aware of the consequences of that, for example in paying higher premiums’.”

However, she said inpatient rehabilitation might be suitable for some patients including the most impaired, those with complications, and those without social support.

“We tend to think it is unsafe for people to go home on their own or with people who are unable to help them.”

In an accompanying editorial in the MJA, past president of the Australian Orthopedic Association Dr Andreas Loefler said neither doctors nor patients were discerning in their use of rehabilitation services and rehab that was no more than ‘visiting a spa for postoperative relaxation’ was not on.

With an increasing demand for joint replacement surgery and a finite health dollar, there was a need for surgeons and rehabilitation physicians to justify the costs of treatment.

“If there are indeed some individuals in our large pool of patients who need extra time and care in hospital, we will need to further analyse the benefits of inpatient rehabilitation for such subgroups.”

“And we should perhaps ask the rehabilitation industry to show cause and to justify their costs,” he said.

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