Is Physical Therapy Clearance Before Arthroplasty Home Discharge Necessary?

NCT05858086 | Recruiting

• 1 other identifier: 12
• Study Type: interventional
• Target: 210
• Locations: 1 country
• Sites: 2

Brief Summary

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.

Conditions

Physical Therapy; Total Joint Arthroplasty; Same-day Discharge

Outcome Measures

Primary Outcomes (1)

• Number of postoperative falls per patient

  6 weeks postoperatively

Secondary Outcomes (6)

• Number of emergency room visits per patient

  90 days postoperatively

• Number of hospital readmissions per patient

  90 days postoperatively

• Patient satisfaction scores

  6 weeks postoperatively

• Patient reported outcome measure

  6 weeks postoperatively

• Patient reported outcome measure

  6 weeks postoperatively

Study Arms (2)

Conventional Postoperative Physical Therapy Clearance

ACTIVE COMPARATOR

Patients will be evaluated and cleared by physical therapy after total joint replacement surgery prior to home discharge

Other: Conventional postoperative physical therapy clearance

Preoperative Physical Therapy, Postoperative Ambulation with Nursing

EXPERIMENTAL

Patients will receive gait/stair training from physical therapy prior to total joint arthroplasty, then ambulate with nursing postoperatively prior to home discharge

Other: Novel same-day discharge protocol after total joint arthroplasty

Interventions

Conventional postoperative physical therapy clearance OTHER

Physical therapy evaluation and clearance after total joint arthroplasty

Conventional Postoperative Physical Therapy Clearance

Novel same-day discharge protocol after total joint arthroplasty OTHER

Preoperative gait/stair training with physical therapy, then postoperative ambulation with nursing after total joint arthroplasty

Preoperative Physical Therapy, Postoperative Ambulation with Nursing

Eligibility Criteria

• Age: 18 Years - 90 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

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:

• 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.

Sponsors & Collaborators

• University of Maryland, Baltimore: lead
• Hospital for Special Surgery, New York: collaborator

Study Sites (2)

University of Maryland

Baltimore, Maryland, 21201, United States

RECRUITING

Hospital for Special Surgery

New York, New York, 10021, United States

NOT YET RECRUITING

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Clinical Professor, Chief of Adult Reconstruction, Director of Orthopaedic Research

Study Record Dates

• First Submitted: December 13, 2022
• First Posted: May 15, 2023
• Study Start: September 27, 2024
• Primary Completion (Estimated): September 1, 2027
• Study Completion (Estimated): December 1, 2027
• Last Updated: February 10, 2026

Record last verified: 2026-02

Locations

US (2)