Is Physical Therapy Clearance Before Arthroplasty Home Discharge Necessary? (PTClearSHoT)

Is Postoperative Physical Therapy Clearance Necessary for Safe Home Discharge After Total Joint Arthroplasty?

Conventionally, physical therapy (PT) clearance is sought before total joint arthroplasty (TJA) discharge. However, PT staffing limitations may preclude same-day discharge in patients having surgery late in the day. Failed same-day discharge in eligible TJA patients results in unnecessary hospital bed occupancy, which increases costs, limits operating room throughput for patients requiring inpatient admission, and introduces risks associated with longer length-of-stay.

In collaboration with an institutional PT department, the investigators developed a protocol for discharging same-day TJA patients without postoperative PT clearance. Immediately preoperatively, PT administers gait training. Patients are then discharged home after ambulating with post-anesthesia care unit (PACU) nurses trained by PT on postoperative mobilization. This allows for the maximum number of patients discharged home, including the last patient of the day, PT staffing limitations notwithstanding. Single-institution pilot data demonstrates no increased risk of falls, emergency room (ER) visits, or readmissions with this process.

The investigators propose a prospective, controlled, multicenter study to expand on pilot data. The study aim is to assess safety of day-of-surgery preoperative PT and postoperative ambulation with PACU nursing before TJA discharge. The primary endpoint is postoperative falls, while secondary endpoints include 90-day ER visits, 90-day hospital readmissions, patient-reported outcome measures, and patient satisfaction scores.

Study Overview

• Status: Recruiting
• Conditions: Physical Therapy; Total Joint Arthroplasty; Same-day Discharge
• Intervention / Treatment: Other: Conventional postoperative physical therapy clearance; Other: Novel same-day discharge protocol after total joint arthroplasty

• Study Type: Interventional
• Enrollment (Estimated): 210
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Baltimore, Maryland, United States, 21201
      • Recruiting
      • University of Maryland
      • Contact: Sumon Nandi; Phone Number: 617-717-8065; Email: sumon.nandi@gmail.com
  • New York
    • New York, New York, United States, 10021
      • Not yet recruiting
      • Hospital for Special Surgery
      • Contact: Matthew Austin

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• are 18 years of age or older
• undergo primary THA or TKA
• are eligible for same-day home discharge (friends or family available to stay at home with the patient for one week postoperatively and medically stable for discharge from PACU per anesthesia).

Exclusion Criteria:

• 90 years of age or older
• have sleep apnea (not eligible for same-day discharge)
• require overnight stay for any reason
• undergo revision THA or TKA.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Conventional Postoperative Physical Therapy Clearance; Patients will be evaluated and cleared by physical therapy after total joint replacement surgery prior to home discharge	Other: Conventional postoperative physical therapy clearance; Physical therapy evaluation and clearance after total joint arthroplasty
Experimental: Preoperative Physical Therapy, Postoperative Ambulation with Nursing; Patients will receive gait/stair training from physical therapy prior to total joint arthroplasty, then ambulate with nursing postoperatively prior to home discharge	Other: Novel same-day discharge protocol after total joint arthroplasty; Preoperative gait/stair training with physical therapy, then postoperative ambulation with nursing after total joint arthroplasty

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Number of postoperative falls per patient	6 weeks postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of emergency room visits per patient		90 days postoperatively
Number of hospital readmissions per patient		90 days postoperatively
Patient satisfaction scores	Surgical Satisfaction Questionnaire-8 (SSQ-8; range 0-100) and numeric satisfaction scale (NSS; range 0-100). Higher scores denote better outcome.	6 weeks postoperatively
Patient reported outcome measure	Knee Injury and Osteoarthritis Outcome Score (KOOS, JR; range 0-100). Higher scores denote better outcome.	6 weeks postoperatively
Patient reported outcome measure	Hip Disability and Osteoarthritis Outcome Score (HOOS, JR; range 0-100). Higher scores denote better outcome.	6 weeks postoperatively
Patient reported outcome measure	Patient-Reported Outcomes Measurement Information System (PROMIS; mean score 50 with standard deviation of 10). Higher scores denote more of measured domain.	6 weeks postoperatively

Collaborators and Investigators

• Sponsor: University of Maryland, Baltimore
• Collaborators: Hospital for Special Surgery, New York

Study record dates

Study Major Dates

• Study Start (Actual): September 27, 2024
• Primary Completion (Estimated): September 1, 2027
• Study Completion (Estimated): December 1, 2027

Study Registration Dates

• First Submitted: December 13, 2022
• First Submitted That Met QC Criteria: May 10, 2023
• First Posted (Actual): May 15, 2023

Study Record Updates

• Last Update Posted (Actual): February 10, 2026
• Last Update Submitted That Met QC Criteria: February 6, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: 12 (Israel lung Association)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No