Home Discharge after Total Knee Arthroplasty Shows Greater Clinically Meaningful Improvement and Fewer Short-Term Complications than Non-Home Discharge: A Propensity Score Matched Study

Abstract In patients undergoing primary total knee arthroplasty (TKA), the association between discharge destination and clinically meaningful improvement in patient-reported outcome measures (PROMs) remains incompletely understood. The purpose of this study was to compare patients discharged home versus non-home following primary TKA with respect to the proportion achieving the Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W) in Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PROMIS PF-10a), PROMIS Global Physical, PROMIS Global Mental, and Knee Injury and Osteoarthritis Outcome Score-Physical Function Short-form (KOOS-PS) scores at 1 year postoperatively. Patients undergoing primary TKA between 2016 and 2023 were identified from an institutional database and 1:3 propensity score-matched based on age, sex, body mass index (BMI), and Charlson Comorbidity Index to compare outcomes between home and non-home discharged patients. Of these patients, 758 were discharged home, and 264 were non-home discharged (inpatient rehab facility or skilled nursing facility). Preoperative and postoperative PROMIS PF-10a, PROMIS Global Physical, PROMIS Global Mental, and KOOS-PS scores were collected. Patients were stratified upon reaching MCID-I, MCID-W, or “no significant change” (score between MCID-W and MCID-I). MCID-W and MCID-I values were determined using a distribution-based method. The threshold values used were from a previously published study utilizing the same database. Non-home-discharged patients demonstrated significantly lower preoperative and postoperative scores in all PROMs. Patients with non-home discharges had lower rates of achieving MCID-I for PROMIS PF-10a (55.8 versus 63.9%, p = 0.024), and a higher rate of achieving MCID-W for PROMIS Global Mental (39.7 versus 32.0%, p = 0.023). A comparison of perioperative outcomes revealed that non-home discharge patients had higher rates of 90-day postoperative complications and revision surgeries. Patients discharged to non-home facilities after TKA demonstrated lower rates of clinically meaningful physical improvement, worse mental health outcomes, and worse short-term perioperative outcomes. These findings suggest that expected functional recovery and perioperative risk should be carefully considered when selecting a discharge destination.