Immediate Physical Therapy following Total Joint Arthroplasty: Barriers and Impact on Short-Term Outcomes.


Background:Recent evidence suggests benefit to receiving physical therapy (PT) the same day as total joint arthroplasty (TJA), but relatively little is known about barriers to providing PT in this constrained time period. We address the following questions: (1) Are there demographic or perioperative variables associated with receiving delayed PT following TJA? (2) Does receiving immediate PT following TJA affect short-term outcomes such as length of stay, discharge disposition, or 30-day readmission? Methods. Primary TJA procedures at a single center were retrospectively reviewed. Immediate PT was defined as within eight hours of surgery. Demographic and perioperative variables were compared between patients who received immediate PT and those who did not. We identified an appropriately matched control group of patients who received immediate PT. Postoperative length of stay, discharge disposition, and 30-day readmissions were compared between matched groups. Results:In total, 2051 primary TJA procedures were reviewed. Of these, 226 (11.0%) received delayed PT. These patients had a higher rate of general anesthesia (25.2% versus 17.8%, p=0.006), later operative start time (13:26 [11:31-14:38] versus 9:36 [8:24-11:16], p<0.001), longer operative time (1.8 [1.5-2.2] versus 1.6 [1.4-1.8] hours, p=0.002), and higher overall caseload on the day of surgery (6 [4-9] versus 5 [4-8], p=0.002). A matched group of patients who received immediate PT was identified. There were no differences in postoperative length of stay or discharge disposition between matched immediate and delayed PT groups, but delayed PT (OR 4.54; 95% CI 1.61-12.84; p=0.004) was associated with a higher 30-day readmission rate. Conclusion:Barriers to receiving immediate PT following TJA included general anesthesia, later operative start time, longer operative time, and higher daily caseload. These factors present potential targets for improving the delivery of immediate postoperative PT. Early PT may help reduce 30-day readmissions, but additional research is necessary to further characterize this relationship.






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Publication Info

Warwick, Hunter, Andrew George, Claire Howell, Cynthia Green, Thorsten M Seyler and William A Jiranek (2019). Immediate Physical Therapy following Total Joint Arthroplasty: Barriers and Impact on Short-Term Outcomes. Advances in orthopedics, 2019. p. 6051476. 10.1155/2019/6051476 Retrieved from

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Cynthia Lea Green

Associate Professor of Biostatistics & Bioinformatics

Survival Analysis
Longitudinal Data Analysis
Logistic Regression
Missing Data
Clinical Trial Methods
Maximum Likelihood Methods


Thorsten Markus Seyler

Associate Professor of Orthopaedic Surgery

Based on a recent market research survey, the U.S. demand for implantable medical devices is forecast to increase 7.7% annually to $52 billion in 2015. While orthopedic implants remain the largest segment, implantable devices are frequently used in urology, cardiovascular specialties, neurology, gynecology, and otolaryngology. With the increased usage of implantable devices, the number of biofilm-associated infections has emerged as a significant clinical problem because biofilms are often resistant to traditional antimicrobial therapy and difficult to eradicate. In fact, biofilm cells show as much as a 1000-fold more resistance to traditional antimicrobial therapy than their planktonic cell counterparts and biofilm-based microbial infections make up to 80% of all infections in patients, leading the CDC to declare biofilms to be one of the most important medical hurdles of the century. 

Since microbial biofilms are a major clinical concern, my lab seeks to (a) advance the ability to diagnose biofilm-associated infections, (b) understanding of the formation of biofilms, and (c) develop/use novel treatment approaches to prevent and treat biofilm-associated infections. 


William Arthur Jiranek

Professor of Orthopaedic Surgery

I am an Orthopaedic physician and work in Adult Reconstructive Orthopaedics, predominantly with hip and knee replacement surgeries. I also help manage revision surgeries and take care of people with infections or fractures around their implants. I am interested in the whole continuum of care for arthritis and not just the surgical treatment of it. Even though I specialize in surgery, not everyone needs that treatment, and as an Orthopaedic doctor, my role is to help direct the whole process. 

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