Enhanced recovery in usual health care improves functional recovery after total knee arthroplasty

Background: The success of total knee arthroplasty (TKA) is determined by an effective surgical procedure as well as a well-organized clinical care pathway. Research has shown that day-of-surgery mobilization decreases length of stay (LOS) and complication rates. We developed, implemented, and evaluated a new clinical care pathway for patients undergoing TKA, that included early mobilization, using 'Lean Six Sigma (LSS)', with the aim of accelerating functional recovery and reducing LOS. Methods: Data derived from physical therapy reports and LOS were compared between the old (n=85) and the new (n=85) clinical care pathways for time to functional recovery (using the modified Iowa Level of Assistance Scale), LOS and joint-related readmission. Group differences were evaluated using Mann-Whitney and Chi-Square tests. The clinical care pathway was redesigned using LSS-methods. Results: After implementation of the new pathway, median time to functional recovery improved from 4 (2-5) to 2 days (1-8)(P <0.001) and LOS from 7 (5-11) to 4 days (3-12)(P