Low value care and inpatient rehabilitation after total knee replacement

A benchmark for the referral rate to inpatient rehabilitation could reduce the evidence–practice gap

There are several reasons why inpatient rehabilitation after total knee replacement (TKR) should be reserved for those most in need. Randomised clinical trials1,2 and observational studies3,4 indicate that inpatient rehabilitation for patients after an uncomplicated TKR is not usually necessary. It is, however, considerably more expensive than the alternatives,1,3,4 whether the cost is borne by the patient, their insurer, or the government. These observations together suggest that the inpatient pathway is often low or no value health care. Further, there is low-level evidence from the United States that rates of re-admission and adverse events, after adjusting for relevant factors, are higher among patients discharged to inpatient rehabilitation or skilled nursing facilities.5,6