Physical therapy after total hip (THR) or total knee replacement (TKR) surgery is standard care for all patients. A new study, appearing in the Journal of Bone & Joint Surgery (JBJS), also found that physical therapy before joint replacement surgery, or “prehabilitation,” can diminish the need for postoperative care by nearly 30 percent, saving an average of $1,215 per patient in skilled nursing facility, home health agency or other postoperative care.
Approximately 50 million U.S. adults have physician-diagnosed arthritis. As the condition progresses, arthritis patients often require THR and/or TKR to maintain mobility and life quality. The number of THRs is expected to grow by 174 percent (572,000 patients) between 2005 and 2030, and TKRs by 673 percent (3.48 million). In recent years, the length of hospital stay following surgeries has decreased from an average of 9.1 days in 1990 to 3.7 days in 2008, while the cost of post-acute care, primarily in skilled nursing facilities and home health agencies, has “skyrocketed.”
Utilizing Medicare claims data, researchers were able to identify both preoperative physical therapy and postoperative care usage patterns for 4,733 THR and TKR patients. Postoperative, or “post-acute” care, was defined as the use of a skilled nursing facility, home health agency or inpatient rehabilitation center within 90 days after hospital discharge. Home health agency services included skilled nursing care, home health aides, physical therapy, speech therapy, occupational therapy and medical social services.
Approximately 77 percent of patients utilized care services following surgery. After adjusting for demographic characteristics and comorbidities (other conditions), patients receiving preoperative physical therapy showed a 29 percent reduction in postoperative care use. In addition:
• 54.2 percent of the preoperative physical therapy group required postoperative care services, compared to 79.7 percent of the patients who did not have preoperative therapy.
• The decline in postoperative care services resulted in an adjusted cost reduction of $1,215 per patient, due largely to lower costs for skilled nursing facility and home health agency care.
• Preoperative physical therapy cost an average of $100 per patient, and was generally limited to one or two sessions.
“This study demonstrated an important opportunity to pre-empt postoperative outcome variances by implementing preoperative physical therapy along with management of comorbidities before and during surgery,” said orthopaedic surgeon Ray Wasielewski, MD, co-author of the study.
Reference: http://www.medicalnewstoday.com/releases/283617.php
Important Information for Patients Considering Total Knee or Total Hip Surgery
A recent study published in the Journal of Bone & Joint Surgery found that attending physical therapy prior to receiving a Total Knee Arthroplasty (TKA) or Total Hip Arthroplasty (THA) can reduce the duration of post-surgical rehabilitation by 30%, saving the patient approximately $1215. The study also found that only 54% of the patients who received pre-surgical physical therapy required post-surgical rehabilitation while nearly 80% of the patients who did not utilize pre-surgical physical therapy required post-operative care.
The objective of attending physical therapy prior to a TKA or THA surgery is to:
• Provide education regarding what to expect following the procedure, assistance you will need to return home, and expectations for full recovery.
• Provide education and training on the beginning phase exercises- research has shown that improving neuromuscular strength and flexibility prior to surgery will hasten the recovery process as your muscles will have improved strength, flexibility and muscle memory.
• Provide strategies to lessen your pain leading up to surgery.
• Improve functional independence before and after your surgery.
If you’re in need of a Total Knee Replacement, talk to Dr. McCall, Shirley, or Wade to see if you are a candidate for pre-surgical therapy. If you are in need of a Total Hip Replacement, talk to Dr. Shirley or Wade about possible pre-surgical therapy.