Fewer days in the hospital after a total knee replacement usually means lower costs. But how do you accomplish that? One way is to begin physiotherapy within the first 24 hours after surgery. And many surgeons are going in this direction.
To help us understand the full impact of this approach, surgeons in Spain evaluated 306 patients with knee osteoarthritis receiving a knee replacement. Two groups of patients were compared. The first group received physiotherapy and started a rehab program within 24 hours of the knee replacement surgery. The second group (with an equal number of patients) began the same rehab program 48 to 72 hours after the replacement procedure.
Patients in both groups were treated in the same hospital by the same physiotherapist following the same exercise program. The therapist used a mobilization program, exercises, breathing, and posture instruction. The program was advanced as quickly as possible based on each patient's performance and tolerance.
Outcomes were measured in terms of knee motion, level of pain, and muscle strength (quadriceps muscles along the front of the thigh and hamstring muscles along the back of the thigh). Function was also assessed using activities of daily living, balance, and walking as the benchmarks.
Patients who started therapy right away stayed in the hospital (on average) of two fewer days compared to the group who received delayed physiotherapy. The early group also got their balance and normal walking pattern back faster compared with the group who started rehab later.
Anyone working patients who have had a total knee replacement knows that not all patients are created equally. There are some who are ready and eager for an exercise program and immediate activity (on day one after surgery).
But there are others who are very slow to move the leg and get out of bed much less make themselves contract muscles and flex and bend the knee. Sometimes the pain (or perception of pain) is just too great in their minds to move smoothly or often.
There are other risk factors that might work against some patients following knee replacement surgery. For example, the patient's state of mind (i.e., mental health) is an important factor. Depression, low self-esteem, anxiety, and fear can interfere with rehab progress.
Getting started and progressing quickly through the program can be a major challenge for some people after a knee replacement. The type of implant used, the way it fits (or doesn't fit) inside the joint, and even specific surgical technique can result in postoperative complications and problems, including failure of the implant.
In summary, according to this study, getting patients up and moving after total knee replacement is the best medicine. The longer the delays and the more days in the hospital, the slower the recovery and the greater the costs associated with the procedure. Physiotherapy to initiate therapy as early as possible is recommended -- both for the patient's benefit and for a cost-savings measure.
Reference: Labraca NS, et al. Starting Rehabilitation Within 24 Hours After Total Knee Arthroplasty Was Better Than Delaying to Within 48 to 72 Hours. In The Journal of Bone and Joint Surgery. February 15, 2012. Vol. 94-A. No. 4. Pp. 366.
Parkway Physiotherapy provides services for physiotherapy in Victoria, Westshore, Langford, Sooke.