Tuesday, August 2, 2011

Follow Up to Channel 10 Story

A recent YNN story which aired on Saturday, July 16th focused on two elements related to joint replacement surgery:
·         Implant materials (surgeon interview)
·         Outcomes after joint replacement surgery (physical therapist interview)
Unfortunately, the two twains of the interviews never intersected and there was no opportunity for the surgeon, board-certified and fellowship trained in adult reconstructive surgery, to weigh in with his expertise on the topic of functionality after total joint replacement surgery.
The  physical therapist interview cited a study (studies) which report findings that significant impairments and functional limitations continue at one year post total knee replacement.1  This study, published more than ten years ago, also clearly had a major design flaw.  Patients in the study group were significantly heavier and had a higher percentage of body fat than the control group members.  This makes the reported findings suspect because clearly the two groups had major differences.
Two more recent publications in the physical therapy literature cite dramatically different findings than the 1998 study.  A recent meta-analysis of the literature published just this year reports that in the areas of perceived physical functioning, functional capacity, and actual daily activity, patients experienced significant improvement postsurgery compared to presurgery.2
Another study (published in 2008) evaluated physical activity after total hip replacement and found that despite having experienced a major surgical procedure, patients having undergone total hip replacement had achieved a level of physical activity consistent with the normative population, and even exceeded the intensity of physical activity for the same group at both light and moderate intensity levels.3
Restoration of mobility and function are obvious reasons to pursue joint replacement surgery, however, the number one reason patients choose to undergo a hip or knee replacement is to obtain relief from debilitating arthritis pain.  Joint replacement surgery is a last resort intervention after more conservative interventions such as physical therapy, medications, and injections have failed.  After the risks, benefits, and alternative options have been thoroughly discussed with the patient, he or she is the sole decision-maker to move forward with joint replacement surgery.  The surgical procedure itself relieves the arthritis pain, but the surgery itself only serves as the conduit for improved motion and function postoperatively.  Patient participation in the postoperative rehabilitation plan is the most important determinant in achieving physical activity goals.

1Walsh, M., Woodhouse, L., Thomas, S., & Finch, E.  Physical Impairments and Functional limitations: a Comparison of Individuals 1 Year after Total Knee Arthroplasty with Control Subjects.  Physical Therapy.  1998; 78(3):  248-254.
2Vissers, M.M., Bussman, J., Jan, V., et al.  Recovery of Physical Functioning after Total Hip Arthroplasty:  Systemic Review and Meta-Analysis of the Literature.  Physical Therapy.  2011; 91(5):  615-629.
3Wagenmakers, R., Stevens, M., Zijlstra, W., Jacobs, M., et al. Habitual Physical Activity Behavior of Patients after Primary Total Hip Arthroplasty.  Physical Therapy.  2008; 88(9):  1039-1048.

Our thanks to Megan Hickey, Manager of PM&R, for her assistance in this review of the physical therapy literature.

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