"If you can get patients to a certain threshold
level, they can do the rest of the rehabilitation on their own,"
coauthor Kenneth Ottenbacher told Reuters Health.
"In a sense, these patients become their own physical therapists,"
Ottenbacher directs the Center for Rehabilitation Sciences at The
University of Texas Medical Branch in Galveston.
He and his team analyzed data from 12,199 U.S. patients who
underwent knee or hip replacement between 2008 and 2010. They were
all living independently before surgery and were treated at
inpatient rehab facilities after the procedure.
Patients were 71 years old, on average, and most were female and
The researchers gathered information on patients' ability to
function at three time points: when they were admitted for surgery,
when they were discharged from the rehab center and three to six
months after discharge.
The functional measures covered everything from eating, bathing and
climbing stairs to memory. Criteria were scored on a scale of 1 to
7, with higher numbers representing better functioning.
When it came to their ability to move around, patients entered
surgery with an average score of 1.6 on that scale. That improved to
4.2 at discharge and 5.6 a few months later.
Because of high costs, not all hip and knee replacement patients can
be referred to inpatient rehabilitation facilities with constant
doctor oversight and intense one-on-one care.
"Generally the patients who get referred to these facilities are
having other health problems," Ottenbacher said, like diabetes or
Patients in his team's study typically entered surgery with multiple
complicating health problems.
"I think this study confirms that acute rehab is a good investment,"
Dr. Robert Bunning told Reuters Health.
Bunning directs the arthritis program at MedStar National
Rehabilitation Hospital in Washington, D.C., and was not involved
with the new study.
Hip and knee replacements are common procedures for older patients
that will only increase as the population ages, and hospitals want
to know how to do these surgeries most efficiently and cheaply,
[to top of second column]
In 2010, a total of 719,000 knee and 332,000 hip replacement
surgeries were performed in the U.S., according to the Centers for
Disease Control and Prevention.
Meanwhile, research presented at the American Academy of Orthopedic
Surgeons annual meeting in 2013 predicted first-time knee
replacements will increase 673 percent to 3.5 million by 2030. In
the same time period, hip replacements are expected to jump 174
percent, researchers led by Steven M. Kurtz of Drexel University in
"The cost of acute rehab facilities should be considered a
reasonable expense," Bunning said. "It's a good treatment and should
be affordable for all patients who show the need for it clinically."
But to answer the question of continued function five or 10 years
post-surgery, a study would need a longer follow-up time, said Jay
Magaziner, an epidemiologist at the University of Maryland School of
Medicine in Baltimore.
"As patients move further away from the surgery and rehabilitation,
they tend to settle into their usual patterns before the
replacement," he said. "And this means that their functionality may
decline again in the future."
Magaziner studies hip fractures but was not part of the new
People who exercised regularly before the surgery will probably
resume their active lifestyles, but, "and this is some speculation,
some patients may start to decline if they return to a slower pace,"
Archives of Gerontology and Geriatrics, online Jan. 24, 2014.
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