Inpatient rehabilitation did not improve mobility among adult patients undergoing uncomplicated total knee arthroplasty at 26 weeks after surgery compared with a home-based monitoring program, according to a study published in JAMA.

Justine M Naylor, PhD, from the Orthopedic Department at Liverpool Hospital in Liverpool, Australia, and colleagues conducted a randomized controlled trial to determine whether inpatient rehabilitation for 10 days followed by a home-based program after total knee arthroplasty provided greater improvements in mobility, function, and quality of life compared with a monitored home-based program alone.

A total of 165 participants (68% women; mean age, 66.9 years) were randomly assigned to receive inpatient hospital rehabilitation followed by an 8-week clinician-monitored home-based program (n=81) or to receive home-based rehabilitation (n=84), and an additional 87 participants were enrolled in the observation group, which included only the home-based program.

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The researchers measured mobility at 26 weeks after surgery with a 6 minute walk test. Secondary outcomes included the Oxford Knee Score, and the EuroQol Group 5-Dimenstion Self Report Questionnaire (EQ-5D) visual analog scale.

The investigators observed no significant difference in the 6-minute walking tests between the inpatient rehabilitation group and either of the 2 home program groups (mean difference, -1.01). The results also showed no difference in patient-reported pain and function (knee score mean difference, 2.06) or quality of life (EQ-5D visual analog scale mean difference, 1.41).

Twelve postdischarge complications were reported in the inpatient group vs 9 in the home program group, and no adverse events were reported.

“Given that the amount of inpatient therapy provided daily in the current study is comparable with that provided in inpatient rehabilitation facilities in the United States, the findings of this study suggest that patients who have undergone arthroplasty are not being disadvantaged by these initiatives in terms of physical recovery,” the study authors noted.

“The findings should also inform rehabilitation models elsewhere, encouraging clinicians to focus on the most cost-effective options. Understanding why inpatient rehabilitation may be associated with higher-level satisfaction (as was the case for our study) would also be useful for informing alternative models.”


  1. Buhagiar MA, Naylor JM, Harris IA, et al. Effect of inpatient rehabilitation vs a monitored home-based program on mobility in patients with total knee arthroplasty: The HIHO randomized clinical trial. JAMA. 2017;317(10):1037-1046. doi:10.1001/jama.2017.1224