Web Based Self Directed Exercise Program is Cost Effective Compared to Formal Physical Therapy after Primary Total Knee Arthroplasty

Authors: Erik Zachwieja ¹, Edwin G Theosmy ², Steven J Yacovelli ¹, Evan W Beatty ³, Mikayla E McGrath ¹, Jess H Lonner ¹

¹Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.

²Department of Orthopaedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ.

³Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, PA.

Abstract

Background

‍Web-based physical therapy (WBPT) is a potential means to reduce costs following total knee arthroplasty (TKA). Although outcomes data support the use of self-directed therapy after TKA, there is a paucity of literature evaluating its cost-effectiveness. This study aimed to determine utilization trends of either outpatient physical therapy (OPPT) or WBPT after TKA, assess the outcomes of patients based on their use of WBPT, OPPT, or both, and evaluate OPPT costs based on the amount of WBPT used.

Methods

‍A retrospective review of 701 patients (731 TKAs) was performed. Patients were given a prescription for OPPT and access to a self-directed WBPT program. Functional scores were obtained preoperatively and 6 months postoperatively, and the rate of manipulation under anesthesia (MUA), range of motion, and PT costs were recorded.

Results

‍About 49.8% of patients utilized WBPT, 34.7% of patients utilized WBPT and OPPT, and 23% of patients utilized neither source of therapy. Patients that utilized both WBPT and OPPT demonstrated the lowest rates of MUA. There were no differences in postoperative outcomes based on the number of WBPT logins. Overall, PT cost was 3.4× higher for those that underwent MUA. Subgroup analysis of patients that utilized WBPT revealed that the cost and number of PT visits decreased as the number of logins increased. Patients younger than 65 utilized more WBPT and OPPT while demonstrating worse outcomes (lower Knee Injury and Osteoarthritis Outcome Score for Joint Replacement postoperative scores and more MUAs).

Conclusion

‍WBPT can be an effective option to offset costs associated with OPPT, without compromising outcomes.