Chances are good that you know someone with “bionic” knees or hips. More than seven million Americans are living with artificial hip and knee joints, according to a prevalence study conducted by the by Mayo Clinic and presented to the American Academy of Orthopedic Surgeons (AAOS) in 2014. An estimated 4.7 million have undergone total knee arthroplasty—reforming of the joint—while 2.5 million have undergone total hip arthroplasty.
The technology enabling the replacement of worn-out, natural joints came into its own almost 50 years ago. The first hip replacement was done in 1969 at the Mayo Clinic, and was followed soon after by the first knee replacement in 1971.
“This large number highlights how these operations have kept a substantial part of our population mobile despite severe arthritis, something that wouldn't have been possible before these technologies were available,” according to Dr. Daniel Berry, orthopedic surgeon at Mayo Clinic.
All these hip and knee replacements have implications for orthopedic care—and that includes the all-important physical therapy that’s required following replacement surgery.
If you or a loved one has been looking into knee or hip replacement, you might have noticed that there have been some changes in the past few years. While Burke, for example, offers orthopedic rehab on both an inpatient and outpatient basis, in the last few years, inpatient rehab has treated fewer patients with unilateral joint replacement.
Why? One reason has to do with insurance coverage. Another is that there are new surgical techniques for hip replacement, for example, where front (anterior) incisions cause less trauma to muscle groups—and this doesn’t require the patient to adhere to such stringent hip precautions. Lastly, more physicians might order “prehab”—outpatient therapy to determine whether joint replacement is indeed necessary. In the process, patients are strengthening their muscles and getting into better condition for impending surgery, and that makes their post-surgical rehabilitation faster and more effective.
Inpatient rehab, however, is important if you’re having a more complicated surgery. When having bilateral (both hips or both knees) joints replaced simultaneously, inpatient rehab offers the benefits of 24/7 nursing care, on site physicians and ongoing pain management. Physical therapy and occupational therapy is intensive—a minimum of three hours a day combined. The average inpatient stay is from 10 to 14 days, and most patients leave Burke walking with just a single cane.
Single joint replacement patients, in contrast, usually do not require the same amount of intensive therapy. They typically do well with two to three weeks of home care therapy, followed by outpatient therapy at one of Burke’s satellite locations near their homes.
Chris Dal Ceredo, Burke’s Program Director of the Orthopedic and Amputee programs, says that although Burke no longer routinely accepts single joint replacement cases on an inpatient basis, “There are circumstances where a person having a single knee replacement, for example, might benefit from inpatient rehab.”
The criteria include a non-routine surgical experience, a fracture that led to the need for joint replacement, advanced age (over 85), existing neurological deficits, a Body Mass Index (BMI) over 50, and co-morbidities, such as congenital issues.
“It’s important for each individual to work with their case worker and physician to determine their best course of therapy, and apply to Burke if they believe inpatient rehab is needed,” continues Dal Ceredo. “We will carefully evaluate their situation.”
Burke’s Orthopedic/Amputee inpatient program also serves patients who have suffered hip or pelvic fractures, had back surgery and patients with an amputation. Those patients average two or three weeks in intensive rehabilitation.
-- Carol Vartuli