With an aging population, the demand for joint arthroplasties has resulted in a surge in the number of joint replacements performed annually. Numerous studies have suggested the need for early, rapid and continuous mobilization with weight bearing after surgery to ensure an optimal outcome. This study examined the ambulatory proficiency of patients discharged to a skilled nursing facility (SNF)．
METHODSThis retrospective study included patients undergoing total joint arthroplasty between November of 2012 and July of 2014. Records were reviewed of those discharged to a SNF, with extracted data including daily visual analog scale pain scores, distances ambulated, weight bearing status at discharge and total length of hospital stay.
RESULTSData concerning 68 patients from 31 sites were included in the final analysis. The average length of acute hospitalization for these patients was 2.9 days and that for SNF stay was 17.5 days. Of the patients studied, 29.4% began gait training on the day of acute hospital discharge, with 63.2% beginning on day one and 7.4% on day two. During the first four days of SNF admission, 35% of the patients had a single physical therapy session, 23.5% had two sessions, 38.2% had three sessions and 2.9% had four sessions. Those who walked on the day of admission (day zero) or the day after admission (day one) experienced a significant decline in distance ambulated (73% and 50% respectively) compared to the last acute hospital physical therapy session (P<0.001 for both comparisons)．
CONCLUSIONThis study of patients with total joint arthroplasties discharged to skilled nursing facilities found a significant decline in ambulation distance on the day of admission and the day after, relative to the last day of acute hospitalization.