Recovery and the use of postoperative physical therapy after total hip or knee replacement

Abstract

Background Total hip or knee arthroplasties (THA/TKA) show favorable long-term effects, yet the recovery process may take weeks to months. Physical therapy (PT) following discharge from hospital is an effective intervention to enhance this recovery process. To investigate the relation between recovery and postoperative PT usage, including the presence of comorbidities, 6 months after THA/TKA. Methods Multicenter, observational study in primary THA/TKA patients who completed preoperative and 6 months postoperative assessments. The assessments included questions on PT use (yes/no and duration; long term use defined as ≥ 12 weeks), comorbidities (musculoskeletal, non-musculoskeletal, sensory comorbidities and frequency of comorbidities). Recovery was assessed with the HOOS/KOOS on all 5 subdomains. Logistic regression with long term PT as outcome was performed adjusted for confounding including an interaction term (comorbidity*HOOS/KOOS-subdomain). Results In total, 1289 THA and 1333 TKA patients were included, of whom 95% received postoperative PT, 56% and 67% received postoperative PT ≥ 12 weeks respectively. In both THA and TKA group, less improvement on all HOOS/KOOS domain scores was associated with ≥ 12 weeks of postoperative PT (range Odds Ratios 0.97–0.99). In the THA group the impact of recovery was smaller in patient with comorbidities as non- musculoskeletal comorbidities modified all associations between recovery and postoperative PT duration (Odds Ratios range 1.01–1.05). Musculoskeletal comorbidities modified the associations between Function-in-Daily-Living-and Sport-and-recreation recovery and postoperative PT. Sensory comorbidities only had an effect on Sport-and-recreation recovery and postoperative PT. Also the frequency of comorbidities modified the relation between Function-in-Daily-Living, pain and symptoms recovery and postoperative PT. In the TKA group comorbidity did not modify the associations. Conclusion Worse recovery was associated with longer duration of postoperative PT suggesting that PT provision is in line with patients’ needs. The impact of physical recovery on the use of long-term postoperative PT was smaller in THA patients with comorbidities. Trial registration Registered in the Dutch Trial Registry on March 13, 2012. TRIAL ID NTR3348; registration number: P12.047. https://www.trialregister.nl/trial/3197.

Perioperative Care Innovations: Optimizing Recovery and Reducing Complications in General Surgery

“…The field of postoperative care has changed dramatically with the introduction of improved recovery after surgery (ERAS) protocols and customised postoperative care plans. To speed up recovery, these tactics include multimodal techniques that include early mobilisation, focused nutritional support, and optimal pain management [7][8] [9].…”

“…Surgical procedures are becoming included in the personalised medicine movement. In order to customise surgical approaches for the best possible results, customised surgical techniques make use of patient-specific data, such as imaging, genetic profiles, and anatomical variances [9]. Surgeons can improve surgical accuracy and precision by facilitating exact anatomical reconstructions through the use of patient-specific 3D-printed models during preoperative preparation.…”

“…Postoperative recovery is greatly aided by individualised rehabilitation regimens that include physiotherapy, occupational therapy, and dietary advice. Customising rehabilitation plans to meet the specific needs of each patient and the demands of surgery promotes better mobility, a more functional recovery, and a lower risk of problems following surgery [9]. The goal of these individualised strategies is to improve patients' quality of life and independence following surgery.…”

“…For the best results, continuity of care must be guaranteed from preoperative planning through postoperative recuperation. Facilitating efficient communication and coordinating patient care across healthcare personnel guarantees smooth transitions and continuous patient support [9][10][11]. Remote monitoring and post-discharge follow-up sessions help to maintain continuity and quickly detect and resolve any postoperative issues.…”

Effect of White Noise Intervention Combined with Multi-dimensional Nursing Mode on Sleep Quality and Incidence of Nosocomial Infection in Patients Undergoing Hip Replacement

“…The multi-dimensional nursing mode is a scientific and comprehensive management mode, and medical staff develop a targeted and operable multi-dimensional nursing plan according to patients’ own situations and clinical experience, from the perspective of patients’ cognition, psychology, behavior, social relations, rehabilitation training, and other dimensions. [ 5 6 7 ] White noise is a random signal or random process with a constant power spectral density, which is generally used in the medical field for adjuvant therapy of some neurological diseases to improve patients’ sleep quality. If white noise intervention combined with multi-dimensional nursing is applied in the clinical practice of patients undergoing HR, patients’ prognosis will be improved to promote their rehabilitation.…”