Specifications Manual for Joint Commission National Quality Measures (v2027A)
Posted: 8/7/2026

Release Notes:
Measure Information Form
Version 2027A

Measure Information Form

Measure Set: Total Hip and Total Knee Replacement Inpatient (THKR-IP)

Set Measure ID: THKR-IP-2

Set Measure ID Performance Measure Name
THKR-IP-2a viewtopic Postoperative Ambulation on Day of Surgery - Hip & Knee Overall
THKR-IP-2b viewtopic Postoperative Ambulation on Day of Surgery - Hip
THKR-IP-2c viewtopic Postoperative Ambulation on Day of Surgery - Knee

Performance Measure Name: Postoperative Ambulation on Day of Surgery

Description: Patients undergoing total hip or total knee replacement who ambulated postoperatively the day of surgery or ambulated in the PACU or within 4 hours of discharge from the PACU.

Rationale: Early postoperative mobilization is a core component of high-quality care for total hip replacement and total knee replacement surgery. The 2020 Enhanced Recovery After Surgery (ERAS®) Society consensus statement on perioperative care for total hip replacement and total knee replacement surgery recommends that patients be mobilized as early as they are able to support functional recovery and facilitate early achievement of discharge criteria (Wainwright et al., 2020). Early mobilization is also recommended to mitigate adverse physiologic effects of postoperative immobility and bed rest, including insulin resistance, muscle atrophy, venous thromboembolism, and postoperative pulmonary complications (Wainwright et al., 2020; Alsuwaylihi et al., 2026).

Evidence supports the safety and effectiveness of early mobilization following total hip and knee arthroplasty. Mobilization within the first 24 hours after surgery is associated with a reduction in hospital length of stay without an increase in the rate of in hospital postoperative adverse events (Guerra et al., 2015). Additionally, evidence from a large multicenter study demonstrates that early mobilization is independently associated with a significant reduction in postoperative complications occurring within 30 days following total hip and knee arthroplasty (Ripollés-Melchor et al., 2020).

Based on recommendations from a Technical Advisory Panel and public comment, this measure was refined to focus on early postoperative ambulation as a more clinically meaningful indicator of mobilization.

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Patients undergoing total hip or total knee replacement who ambulated postoperatively the day of surgery or ambulated in the PACU or within 4 hours of discharge from the PACU.
Included Populations:
  • Postoperative ambulation (walking) on the day of surgery
  • Postoperative ambulation (walking) in the PACU or within 4 hours of discharge from the PACU

Excluded Populations: None

Data Elements:

Denominator Statement: Patients undergoing a total hip or total knee replacement.
Included Populations:
  • Patients with an ICD-10-PCS Principal Procedure Code as defined in Appendix A: Table 14.01a Total Hip Replacement or Table 14.02a Total Knee Replacement

Excluded Populations:
  • Patients less than 18 years of age
  • Patients who have a Length of Stay greater than 120 days
  • Patients with an ICD-10-PCS Other Procedure Code as defined in Appendix A: Table 14.05a (partial hip and partial knee replacements), or Table 14.06a (revision and resurfacing procedures, or Table 14.07a (removal of implanted devices/prostheses)
  • Patients with an ICD-10-CM Principal Diagnosis Code or ICD-10-CM Other Diagnosis Code as defined in Appendix A: Table 14.08 (complication of Internal Fixation Device/Prosthesis) or Table 14.09 (malignant neoplasm of the pelvis, sacrum, coccyx, lower limbs, or bone/bone marrow or a disseminated malignant neoplasm), or Table 14.10 (Fractures)
  • Postoperative patients who are admitted to ICU on Principal Procedure Date or PACU Discharge Date
  • Patient expired on Principal Procedure Date
  • Patient expired on PACU Discharge Date
  • Patient left AMA on PACU Discharge Date
  • Documented contraindication by physician/APN/PA/nurse/physical therapist/occupational therapist for not ambulating on day of surgery (e.g. nerve block has not worn off, hypotensive upon standing, patient is vomiting)

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal or other ICD-10 diagnosis and procedure codes, which require retrospective data entry.

Data Accuracy: Variation may exist in the assignment of ICD-10 codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. Please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications Section.

Data Reported As: Aggregate rate generated from count data reported as a proportion. Proportion for hip replacements, proportion for knee replacements and aggregated proportion for hip & knee replacements.

Selected References:
  • Alsuwaylihi, A., O'Connor, D., Joshi, G. P., Kehlet, H., and Lobo, D. N. (2026). Importance of early postoperative mobilization: Comprehensive review. BJS Open, 10 (2), zrag016. https://doi.org/10.1093/bjsopen/zrag016
  • Guerra, M. L., Singh, P. J., and Taylor, N. F. (2015). Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: A systematic review. Clinical Rehabilitation, 29 (9), 844–854. https://doi.org/10.1177/0269215514558641
  • Ripollés-Melchor, J., Abad-Motos, A., Díez-Remesal, Y., Aseguinolaza-Pagola, M., Padin-Barreiro, L., Sánchez-Martín, R., Logroño-Egea, M., García-Orallo, S., Ramirez-Rodriguez, J. M., and POWER2 Study Investigators Group. (2020). Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2). JAMA Surgery, 155 (4), e196024. https://doi.org/10.1001/jamasurg.2019.6024
  • Wainwright, T. W., Gill, M., McDonald, D. A., Middleton, R. G., Reed, M., Sahota, O., Yates, P., & Ljungqvist, O. (2020). Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta Orthopaedica, 91 (1), 3–19. https://doi.org/10.1080/17453674.2019.1683790

Measure Algorithm:
Graphic depiction of the Measure Algorithm. Refer to the Algorithm Narrative for each detailed step. Graphic depiction of the Measure Algorithm. Refer to the Algorithm Narrative for each detailed step.

THKR-IP-2: Algorithm Narrative

THKR-IP-2: Inpatient Postoperative Ambulation on Day of Surgery

Numerator: Patients undergoing total hip or total knee replacement who ambulated postoperatively the day of surgery or in the PACU or within 4 hours of discharge from the PACU.
Denominator: Patients undergoing a total hip or total knee replacement.

Variable Key:
Initial Discharge Day I
Initial Discharge Day II
Initial Ambulation Day
Initial Ambulation Time

Stratification Table:
If Measure ID is THKR-IP-2a, then the Stratified Measure Name is Overall Rate.
If Measure ID is THKR-IP-2b, then the Stratified Measure Name is Hip.
If Measure ID is THKR-IP-2c, then the Stratified Measure Name is Knee.

1. Start processing. Run cases, which are included in the THKR Inpatient Initial Patient Population and pass the edits defined in the Clinical Data Processing Flow, through this measure.

2. Check ICD-10 CM Principal or Other Diagnosis codes
  1. If at least one of the ICD-10 CM Principal or Other Diagnosis codes is on Table 14.10, the case will proceed to a Overall Rate Category Assignment of B and will not be in the Measure Population.
  2. If none of the ICD-10 CM Principal or Other Diagnosis codes are on Table 14.10, continue processing and proceed to check Postoperative ICU Admit or Transfer.

3. Check Postoperative ICU Admit or Transfer.
  1. If Postoperative ICU Admit or Transfer is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 22.
  2. If Postoperative ICU Admit or Transfer equals Y, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Proceed to Step 22.
  3. If Postoperative ICU Admit or Transfer equals N, continue processing and proceed to check ICD-10-PCS Principal Procedure Date.

4. Check ICD-10-PCS Principal Procedure Date.
  1. If ICD-10-PCS Principal Procedure Date is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 22.
  2. If ICD-10-PCS Principal Procedure Date equals UTD, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Proceed to Step 22.
  3. If ICD-10-PCS Principal Procedure Date is Non-UTD value continue processing and proceed to check Discharge Disposition.

5. Check Discharge Disposition.
  1. If Discharge Disposition is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 22.
  2. If Discharge Disposition equals 6, continue processing and proceed to calculate Initial Discharge Day I.
  3. If Discharge Disposition equals 1, 2, 3, 4, 5, 7 or 8, continue processing and proceed to Step 8, to check PACU Discharge Date.

6. Calculate Initial Discharge Day I (in days). Initial Discharge Day I, in days, is equal to the Discharge Date minus ICD-10-PCS Principal Procedure Date, continue processing and proceed to check Initial Discharge Day I.

7. Check Initial Discharge Day I
  1. If Initial Discharge Day I is less than 0 days, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 22.
  2. If Initial Discharge Day I is equal to 0 days, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Proceed to Step 22.
  3. If Initial Discharge Day I is equal to or greater than 1 day, continue processing and proceed to check PACU Discharge Date

8. Check PACU Discharge Date.
  1. If PACU Discharge Date is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 22.
  2. If PACU Discharge Date equals UTD, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Proceed to Step 22.
  3. If PACU Discharge Date is Non-UTD value continue processing and proceed to check PACU Discharge Time.

9. Check PACU Discharge Time.
  1. If PACU Discharge Time is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 22.
  2. If PACU Discharge Time equals UTD, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Proceed to Step 22.
  3. If PACU Discharge Time is Non-UTD value continue processing and proceed to check Discharge Disposition.

10. Check Discharge Disposition.
  1. If Discharge Disposition equals 6 or 7, continue processing and proceed to calculate Initial Discharge Day II.
  2. If Discharge Disposition equals 1, 2, 3, 4, 5 or 8, continue processing and proceed to Step 13, to check Ambulation.

11. Calculate Initial Discharge Day II (in days). Initial Discharge Day II, in days, is equal to the Discharge Date minus PACU Discharge Date, continue processing and proceed to check Initial Discharge Day II.

12. Check Initial Discharge Day II
  1. If Initial Discharge Day II is less than 0 days, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 22.
  2. If Initial Discharge Day II is equal to 0 days, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Proceed to Step 22.
  3. If Initial Discharge Day II is equal to or greater than 1 day, continue processing and proceed to check Ambulation

13. Check Ambulation.
  1. If Ambulation is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 22.
  2. If Ambulation equals N, continue processing and proceed to check Reason for Not Ambulating the Day of Surgery.
  3. If Ambulation equals Y, continue processing and proceed to Step 15, to check Ambulation Date.

14. Check Reason for Not Ambulating the Day of Surgery.
  1. If Reason for Not Ambulating the Day of Surgery is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 22.
  2. If Reason for Not Ambulating the Day of Surgery equals N, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Proceed to Step 22.
  3. If Reason for Not Ambulating the Day of Surgery equals Y, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Proceed to Step 22.

15. Check Ambulation Date.
  1. If Ambulation Date is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 22.
  2. If Ambulation Date equals UTD, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Proceed to Step 22.
  3. If Ambulation Date is Non-UTD value continue processing and proceed to calculate Initial Ambulation Day.

16. Calculate Initial Ambulation Day (in days). Initial Ambulation Day, in days, is equal to the Ambulation Date minus ICD-10-PCS Principal Procedure Date, continue processing and proceed to check Initial Ambulation Day.

17. Check Initial Ambulation Day
  1. If Initial Ambulation Day is less than 0 days, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 22.
  2. If Initial Ambulation Day is equal to 0 days, the case will proceed to a Measure Category Assignment of E and will be in the numerator population. Proceed to Step 22.
  3. If Initial Ambulation Day is greater than 0 day, continue processing and proceed to check Ambulation Time

18. Check Ambulation Time.
  1. If Ambulation Time is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 22.
  2. If Ambulation Time equals UTD, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Proceed to Step 22.
  3. If Ambulation Time is Non-UTD value continue processing and proceed to calculate Initial Ambulation Time.

19. Calculate Initial Ambulation Time (in hours). Initial Ambulation Time, in hours, is equal to the Ambulation Date and Ambulation Time minus PACU Discharge Date and PACU Discharge Time, continue processing and proceed to check Initial Ambulation Time.

20. Check Initial Ambulation Time
  1. If Initial Ambulation Time is equal to or less than 4 hours, the case will proceed to a Measure Category Assignment of E and will be in the numerator population. Proceed to Step 22.
  2. If Initial Ambulation Time is greater than 4 hours, continue processing and proceed to check Reason for Not Ambulating the Day of Surgery

21. Check Reason for Not Ambulating the Day of Surgery.
  1. If Reason for Not Ambulating the Day of Surgery is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 22.
  2. If Reason for Not Ambulating the Day of Surgery equals N, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Proceed to Step 22.
  3. If Reason for Not Ambulating the Day of Surgery equals Y, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Proceed to Step 22.

22. Initialize the Measure Category Assignment for each Strata Measure THKR-IP-2b and THKR-IP-2c to B, Not In Measure Population. Do not change the Measure Category Assignment that was already calculated for the overall rate,THKR-IP-2a. Proceed to check Overall Rate Category Assignment.

23. Check Overall Rate Category Assignment.
  1. If Overall Rate Category Assignment equals B Stop Processing.
  2. If Overall Rate Category Assignment equals D or E or X continue processing and proceed to check ICD-10-PCS Principal Procedure Code.

24. Check ICD-10-PCS Principal Procedure Code.
  1. If ICD-10-PCS Principal Procedure Code is on Table 14.01a, Set the Measure Category Assignment for Measure THKR-IP-2b equal to Measure Category Assignment for Measure THKR-IP-2a. Stop processing.
  2. If ICD-10-PCS Principal Procedure Code is on Table 14.02a, Set the Measure Category Assignment for Measure THKR-IP-2c equal to Measure Category Assignment for Measure THKR-IP-2a. Stop processing.

Measure Information Form THKR-IP-2
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Specifications Manual for Joint Commission National Quality Measures (v2027A)
Discharges 01-01-2027 (1Q27) through 06-30-2027 (2Q27)

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