Formal Physical Therapy Following Total Hip and Knee Arthroplasty Incurs Additional Cost Without Improving Outcomes |
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| Institution: | 1. Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA;2. Philadelphia College of Osteopathic Medicine, Philadelphia, PA;1. Department of Orthopedic Surgery, NYU Langone Health, New York, NY;2. Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI;1. Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea;2. Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Republic of Korea;3. Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea;1. Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH;2. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL;3. Department of Orthopaedic Surgery, Emory University, Atlanta, GA;4. Clinical Quality and Value Department, American Academy of Orthopaedic Surgeons, Rosemont, IL;5. Anderson Orthopedic Research Institute, Alexandria, VA;1. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom;2. Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom;3. Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom |
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| Abstract: | BackgroundRecent evidence has demonstrated that formal physical therapy (PT) may not be required for most patients undergoing total hip (THA) and knee (TKA) arthroplasty. This study compared the differences in costs and functional outcomes in patients receiving formal PT and those who did not follow primary THA and TKA.MethodsWe queried claims data from a single private insurer identifying patients who underwent primary THA or TKA from 2015 to 2017 in our practice. Demographics, comorbidities, number, and cost of PT visits in a 90-day episode of care were recorded. Outcomes were compared between patients using self-directed home exercises, home PT, outpatient PT, or both home and outpatient PT. A multivariate analysis was performed to identify significant predictors of outcomes.ResultsOf the 2971 patients included in analysis, patients using both services had higher 90-day PT costs (mean $2091, P < .001) than those using home PT alone ($1146), outpatient PT alone ($1356), or no formal PT ($0). Home PT had the greatest cost per visit for both private insurance patients ($177/visit) and Medicare Advantage patients ($157/visit), but patients using both home PT and outpatient PT services had the greatest overall PT cost, $2091 for private insurance and $1891 for Medicare Advantage. Patients who used home PT were at significantly higher risk of both complications (odds ratio = 3.21; 95% confidence interval, 2.1-4.9; P < .001) and readmissions (odds ratio = 3.4; 95% confidence interval, 2.1-5.5; P < .001).ConclusionParticipation in formal PT accounts for up to 8% of the episode of care following THA and TKA. The role of formal PT for most patients should take into account the cost-effectiveness of the intervention. |
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| Keywords: | total hip arthroplasty total knee arthroplasty physical therapy episode of care cost analysis |
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