Patients Living Alone Can Be Safely Discharged Directly Home After Total Joint Arthroplasty: A Prospective Cohort Study

J Bone Joint Surg Am. 2018 Jan 17;100(2):99-106. doi: 10.2106/JBJS.17.00067.


Background: Despite the expense and potential hazards of inpatient rehabilitation, there is a prevailing belief that patients living alone cannot be safely discharged directly home after total joint arthroplasty. The purpose of this study was to assess the safety and efficacy of direct home discharge for patients living alone during convalescence after primary total joint arthroplasty.

Methods: We prospectively studied 910 consecutive patients undergoing primary, unilateral total hip arthroplasty or total knee arthroplasty over an 8-month period. Patients discharged directly home who were living alone for the first 2 weeks after the surgical procedure were identified as the investigational group and those discharged to home and living with others constituted the control group. The primary outcomes were 90-day complications and unplanned clinical events, including readmissions, emergency department or urgent care visits, and office visits. Functional outcomes, patient satisfaction, pain relief, and return to daily function were also assessed.

Results: During the study period, 874 patients (96%) were discharged directly home and only 36 patients (4%) were discharged to a rehabilitation facility. Of those discharged home, 769 patients were included in the final analysis, including 138 patients living alone and 631 patients living with others, and 105 patients were excluded as they opted not to participate. Patients living alone more commonly stayed an additional night in the hospital and utilized more home health services. There was no increase in complications or unplanned clinical events for patients living alone compared with those living with others. Further, no significant differences in functional outcomes or pain relief were detected, and satisfaction scores were equivalent after 90 days.

Conclusions: Patients living alone had a safe and manageable recovery when discharged directly home after total joint arthroplasty. Extending the initial hospitalization and providing home health services on a selected basis may be a more cost-effective approach than routine discharge to an inpatient rehabilitation facility.

Level of evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Publication types

  • Observational Study

MeSH terms

  • Activities of Daily Living
  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip*
  • Arthroplasty, Replacement, Knee*
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Humans
  • Independent Living*
  • Male
  • Middle Aged
  • Office Visits / statistics & numerical data
  • Pain Management
  • Patient Discharge*
  • Patient Readmission / statistics & numerical data
  • Patient Satisfaction / statistics & numerical data
  • Postoperative Complications
  • Prospective Studies
  • Single Person*