Cumulated Ambulation Score and Length of Hospital Stay After TKA

The number of patients who receive a total knee arthroplasty (TKA) is steadily increasing and although the reliability and the results of this procedure are excellent, intensive functional rehabilitation is needed postoperatively to obtain satisfactory range of motion. Currently, the standard length of stay at our hospital is between 8 and 10 days for patients who undergo TKA.

The length of stay depends not only on factors such as early mobilization, pain management, major or minor complications and logistical or organizational problems (1) (2). It also depends on the availability of adequate services when the patient needs to be transferred to an appropriate facility. Each of these steps can be further developed in order to improve the quality of care for patients, reduce hospital costs and increase the availability of beds (3). As a result, the reduction in average length of stay would not only result in a reduction in cost but also a greater turnover in the number of patients. Several studies show that the application of a post-operative fast-track strategy may reduce the length of stay in a very significant manner with benefit for patients and hospitals (3).Thus, if their condition allows, patients would have rapid post-operative rehabilitation, with early joint mobilization at D0 (operative day) and walking from D1 (the first post-operative day).

The Cumulated Ambulation Score (CAS) (4) is a tool developed and tested for initial predicting the in-patient length of stay following a hip surgery. The CAS consists of documenting the patient's ability and independence while performing 3 basic daily activities (sit to stand, transfer out of bed and mobilization). It is calculated using a score of 0-2 for each parameter, giving a total daily score of 0 to 6 and a score of 0 to 18 during the first 3 post-operative days. The CAS is then the sum of scores of the first 3 post-operative days. This score proves to be an effective tool for predicting the length of stay, and other parameters investigated such as survival rate and return home after a proximal femoral surgery.