IMPROVING EFFICIENCY OF REIIABILITATION AFTER TOTAL HIP/KNEE ARTHROPLASTY FOR ARTHRITIS
Michael K. Yoshida (Medical College of Wisconsin, Milwaukee, USA)
Purpose: Successful arthroplasty rehabilitation is related to rigorous adherence to clinical pathway, frequent communication among staff, and skillful medical management. This study examines the results and complications during recovery and rehabilitation of hip/knee arthroplasties.
Method: Data were collected between September 1993 and January 1997. Two hundred six cases of hip arthroplasty and 264 cases of knee arthroplasty were measured for rehabilitation function according to FIM scores upon admission and discharge from rehabilitation unit. Complications were analyzed.
Results: The vast majority of post-operative arthroplasty patients rehabilitated successfully and returned to home. Major complications occurred in about 7% of in-patients and included decreased cognitive function, urinary retention, myocardial infarction, hypoxemia, SIADH, deep venous thrombosis/pulmonary embolism, bowel obstruction, acute renal failure, dislocation of the hip, and fractures.
Conclusion: Key factors in effective arthroplastic rehabilitation and quick discharge include careful orchestration of pre-operative physical therapy and patient/family education, and post-surgical adherence to the clinical pathway by the arthroplasty ward team. Rehabilitation consultation was initiated on postoperative day 0 (POD0). Transition from acute arthroplasty ward to rehabilitation unit occurred on POD4-7. Close teamwork among rehabilitation staff shortens hospitalization and maintains a high quality of medical care. Patients were discharged home after 10-14 days. In-patient staff continued close contact with physical therapists and nurses who visited the patients at home.
AQUATIC THERAPY FOR PERSONS WITH OSTEOARTHRITIS AND CORONARY ARTERY DISEASE
Thomas W. Findley (UMDNJ-School of Osteopathic Medicine, Stratford, N J), CW Cortes, TP Stein, DM Janora, WT Boone
Many persons with Osteoarthritis (OA) are predisposed to coronary artery disease (CAD) and the associated increase in morbidity and mortality. Furthermore, a substantial proportion of persons requiring cardiac rehabilitation are unable to participate in standard exercise programs because of arthritic conditions. Both OA and CAD are common conditions in the elderly population. Exercise programs have been developed for each condition individually, based on an understanding of the physiological processes involved, but little information is available on the physiological response to exercise for persons with both these conditions. Physiological data on the responses of therapeutic exercise in persons with OA primarily looks at muscle strength; also the cardiovascular responses in water are not well elucidated in persons with both OA and CAD. It is expected that aerobic exercise will increase vascularization of peripheral tissues and that this response will be augmented by aquatic exercise. Theoretically, the intensity of exercise in the water will allow the person with OA and CAD to increase peripheral extraction by increasing the efficiency of the peripheral circulation, thereby reducing myocardial oxygen demand. Another anticipated benefit is the increased possible caloric expenditure which may result in weight loss and reduced stress on the arthritic hip or knee as well as on the heart. This paper presents the physiological rationale to develop a clinical aquatic exercise program with an emphasis on functional outcomes, using treadmill exercise in water for cardiac rehabilitation of the person with osteoarthritis.