Pain and function pre- and post-surgery
When surveyed, total knee replacement patients rate their satisfaction as very high when inquired about pain differences pre- and post-surgery. In contrast to the self reported outcomes, functional performance measures (e.g. the timed stair-climbing or walking test) depict only modest improvements following total knee arthroplasty (TKA).3 TKA reduces pain and improves health-related quality of life in 90% of patients.4 However, when asked about function, these same patients rate their satisfaction very low one year post knee replacement.5,6
Pain and function post surgery compared to non-TKA individuals
The goals of total knee arthroplasty are to decrease pain, improve functional mobility – such as walking and stair climbing – and promote return to physical activity. It is well established that TKA reduces pain post surgery; however, 30% of patients report dissatisfaction in their physical abilities one year following the surgery.5
Some staggering statistics:
- One year after post-op, TKA patients walk 18% slower, climb stairs 51% slower, and have quadriceps deficits of nearly 40% compared to their age-matched non-TKA counterparts.6,7
- Approximately 75% of TKA patients report difficulty negotiating stairs.6
- 24% of total knee patients fall in the first year.8
Yet, only 26% of TKA patients are referred to outpatient rehabilitation following total knee arthroplasty.9
Based on the information above, we must critically examine and re-think today’s rehabilitation programs for TKA. Failure to do so can definitely impede the recovery of the TKA patient’s long-term functional abilities.
Rehabilitation for total joint replacement patients
In anticipation of the Medicare bundling of reimbursement payment system, it will be imperative for the rehabilitation clinician to offer “value over volume.” It is my personal goal and passion to investigate and study functional exercises designed for the joint replacement patient. I have recently been cited in a research paper for the development of an exercise that can assist in the total knee patient facilitating a faster return to normal gait pattern.10
My next challenge will be to look at the total hip patient, specifically my “Gait Assistive Exercises,” from my MedBridge Joint Replacement course (see the video below). The set of exercises presented will be a game changer in your rehabilitation of today’s joint replacement patient and thus separate you and your facility from the competition. This will be imperative with the future of joint replacement rehab, specifically the bundling payment system that rewards facilities and hospital systems that demonstrate outcomes exceeding the benchmarks.