Monday, March 14, 2016

After Hip Replacement, Therapy at Home May Be Enough

Experts say that physical therapy plays a vital role in recovery after hip replacement. This new study of 77 patients found they obtained similar results no matter which therapy option they pursued after receiving their new hip.

“Our research found that the physical therapy does not necessarily need to be supervised by a physical therapist [for hip replacement patients],” said study author Dr. Matthew Austin, director of joint-replacement services at Rothman Orthopaedic Specialty Hospital in Bensalem, PA. “The expense and time required of outpatient physical therapy, both for the patient and the patient’s caretakers, may not be the most efficient use of resources.”

More than 300,000 total hip replacements are performed each year in the United States, according the U.S. Centers for Disease Control and Prevention. Hip replacement, or arthroplasty, is a surgical procedure in which parts of the hip joint are removed and replaced with new, artificial parts. The surgery is intended to restore function to the joint.

For their study, Austin and his colleagues randomly assigned half of the 77 hip replacement patients to two months of formal outpatient physical therapy, with two to three sessions a week. The others did only prescribed exercises on their own for two months.

Patient progress was measured at one month and six months after the operation. Investigators evaluated them according to ability to walk, use stairs, sit comfortably, flex and other factors that gauge motion.

No significant differences were found between the two groups. The study authors concluded that treatment for hip replacement might move away from routinely prescribing formal physical therapy.

Most patients who undergo total hip replacement are between the ages of 50 and 80, according to the American Academy of Orthopaedic Surgeons.

The study findings were to be presented Friday at the annual meeting of the American Academy of Orthopaedic Surgeons, in Orlando, FL. In general, data and conclusions presented at meetings are considered preliminary until published in a peer-reviewed medical journal.

My Take:
I’m all in favor of reduced health care costs as long as the patient doesn’t suffer from a lack of adequate care. In this study, Dr. Austin and his colleagues evaluated several factors to gauge recovery. However, in my experience, non-weight bearing range of motion is generally the sole criteria used by both surgeons and physical therapists to evaluate recovery.

My mother-in-law recently had bilateral knee joint replacement and I accompanied her to her two month post-op orthopedic evaluation. After the surgeon finished his exam where he raved about her recovery, he asked me what concerns I had. There were three: Lack of leg strength, a horrible gait when walking, and an apparent foot drop. He responded, “I haven’t seen her walk.” And I responded, “Yes, I know.” He asked her to walk across the examination room and was appalled at her struggle to stand and walk. Until that moment, his sole criteria for her surgical outcome was how far he could flex the knees.

I am convinced my mother-in-law’s limited recovery is due to a lack of adequate physical therapy. Her range of joint motion was great immediately following surgery and her therapist frequently remarked that she didn’t need therapy.

Now we are playing catch-up. She has joined a gym and I have prescribed specific exercises to strengthen her legs. I corrected her gait and she is slowing gaining strength. I don’t know if she will ever recoup the loss created by the lack of proper therapy, but I remain optimistic.

The Bottom Line:
Physical therapy after joint replacement is vital to a good long term prognosis. I still recommend aggressive therapy for 2-3 months after orthopedic surgery.

Source: March 4, 2016 National Institutes of Health

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