Table of Contents
Advances in Orthopedic Surgery
Volume 2015, Article ID 387197, 7 pages
Clinical Study

Implementation of an Accelerated Rehabilitation Protocol for Total Joint Arthroplasty in the Managed Care Setting: The Experience of One Institution

1Harbor UCLA Medical Center, Department of Orthopaedics, 1000 W. Carson Street Box 422, Torrance, CA 90245, USA
2Kaiser West Los Angeles, Department of Orthopaedics, 6041 Cadillac Avenue, Los Angeles, CA 90034, USA

Received 5 August 2015; Revised 28 October 2015; Accepted 16 November 2015

Academic Editor: Guoxin Ni

Copyright © 2015 Nicholas B. Robertson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Accelerated rehabilitation following total joint replacement (TJR) surgery has become more common in contemporary orthopaedic practice. Increased utilization demands improvements in resource allocation with continued improvement in patient outcomes. We describe an accelerated rehab protocol (AR) instituted at a community based hospital. All patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) were included. The AR consisted of preoperative patient education, standardization of perioperative pain management, therapy, and next day in-home services consultation following discharge. Outcomes of interest include average length of stay (ALOS), discharge disposition, 42-day return to Urgent Care (UC), Emergency Department (ED), or readmission. A total of 4 surgeons performed TJR procedures on 1,268 patients in the study period (696 TKA, 572 THA). ALOS was reduced from 3.5 days at the start of the observation period to 2.4 days at the end. Discharge to skilled nursing reduced from 25% to 14%. A multifaceted and evidence based approach to standardization of care delivery has resulted in improved patient outcomes and a reduction in resource utilization. Adoption of an accelerated rehab protocol has proven to be effective as well as safe without increased utilization of UC, ER, or readmissions.