Knee Replacement Patients Report Similar Outcomes With or Without Home Health Services

Home health services may benefit some patients following total knee arthroplasty (TKA), but not all need it, new Cleveland Clinic research suggests.

As demand for TKA continues to grow, delivery of value-based postsurgical care becomes increasingly important. At many medical centers, patients who have TKA are routinely discharged to home health services, receiving home visits by healthcare professionals who provide assistance and monitoring during recovery. Such care incurs cost, yet there is limited data on whether patients feel they have benefited from the care.

“The number of total joints being performed in the U.S. keeps increasing, but our resources are not infinite,” says Nicolas S. Piuzzi, MD, Enterprise Vice Chair of Research for Orthopaedics and Rehabilitation at Cleveland Clinic. “We need to use our limited resources wisely, allocating them to patients appropriately.”

Among more than 10,000 patients who had TKA at Cleveland Clinic from 2016 to 2022, those discharged to home health services didn’t uniformly report better outcomes than those who engaged in self-care at home. This suggests there is potential for better risk stratification, Dr. Piuzzi says.

“Overall, patients who had home health services achieved similar improvement at one year as those who had only self-care,” he says. “For us, this is reassurance that in correctly selected patients, we might achieve the same levels of satisfaction and improvement regardless of the care path.”

Dr. Piuzzi and the Cleveland Clinic Adult Reconstruction Research (CCARR) team will present these findings at the 2025 American Academy of Orthopaedic Surgeons meeting.

Comparing outcomes of home health and self-care patients

Of the total 10,084 primary TKA patients, 6,963 were discharged to home health services and 3,121 were discharged home with self-care. At one year, the two groups had similar improvements in a variety of patient-reported outcome measures.

For example, the proportions reporting a minimum clinically important difference on the Knee Injury and Osteoarthritis Outcome Score Physical Function Shortform (KOOS-PS) one year after surgery were about 85% in both home health and self-care groups. Proportions also were similar for KOOS-Pain (about 93%) and KOOS-Joint Replacement (KOOS-JR) (about 91%). None of the differences between treatment groups were statistically significant.

The proportions achieving a patient acceptable symptomatic state (PASS) also were similar in both groups — about 66% for KOOS-PS, about 69% for KOOS-Pain and 68% for KOOS-JR.

However, those with self-care did express less satisfaction in PASS responses (OR 0.87, P = .013).

The findings aren’t entirely surprising, Dr. Piuzzi says.

“With changes in outpatient surgery and other advances, we’re starting to see more patients who are younger and healthier, who may do well with self-care, outpatient physical therapy or other modes of recovery.”

Determining who really needs home health services

More work will be required to determine who will benefit most from home health services.

“We need to continue to develop evidence-based criteria and decision-support tools to guide discharge planning and optimize postacute care pathways based on multiple factors, such as patient preference, their social support and their current level of activity,” Dr. Piuzzi says.

Among Dr. Piuzzi and the CCARR’s upcoming projects: using wearable sensors to detect patients’ activity levels prior to surgery. Studying that data could help identify factors that predict who may be able to recover with minimal professional assistance.

Their findings could benefit all of orthopaedic surgery.

“There’s a lot of heterogeneity in the field,” Dr. Piuzzi says. “I think that’s an area for improvement. We need more standardization based on solid evidence.”

Another stage in the evolution of TKA recovery

This work illustrates the evolution of TKA recovery, he notes. About a decade ago, 30%-40% of people were discharged to inpatient rehabilitation centers after TKA. Today, 90% are discharged home.

“Now that more patients are at home instead of a rehab center, can we provide virtual support — care via technology?” Dr. Piuzzi asks. “A lot of centers and surgeons are applying a multidisciplinary team approach to this. But it’s always good to have data to guide the decision-making.”