Waiting time for TKR and THR in Canada

Staistics published in Canadian Medical Association Journal CMAJ and using statistics from the Canadian Institute for Health Information Research  (CIHI) (CIHR) looks at waiting times for hip and knee replacement surgery along with hip fracture repair, is Canada. Total hip and knee surgery is a priority procedure in Canada with a targeted wait time of 182 days.

It’s a complicated problem,” says Kathleen Morris, director of health system analysis and emerging issues at CIHI. Although there are more procedures performed year on year the provinces aren’t keeping up with rising demand. “They’re chasing a moving target because there’s an increasing number of people queuing up [for treatment].”, The report acknowledges that each province came from a different starting point regarding health care. Morris says that the provinces have done a lot of work recently to improve access., “The feeling that most of us have is that we’re getting close to the maximum efficiency we can have while still being safe,” says Dr. James Waddell, an orthopedic surgeon at St. Michael’s Hospital in Toronto, Ontario said that the wait time may also be due to some patients waiting for a particular surgeon with a great reputation for the elective surgery.

 

Determining who should be referred for total hip and knee replacements.

Published in Nature Reviews Rheumatology , 03/13/2013 Dr. Mandl LA from the Hospital for Special Surgery, USA. looks at which patients with end-stage arthritis, should undergo Total hip and total knee replacements (THR and TKR respectively).

Patients with moderate-to-severe chronic hip or knee pain and disability undergoing arthroplasty or total joint replacement TJR see a relief of pain and an improvement in function. Primary care physicians or General practitioners decide which patients are candidates for total joint replacement (TJR) procedures. However there is no evidence-based criteria exist to guide physicians in this decision-making process, and this situation raises the possibility that conscious or unconscious biases may influence referral patterns.

Exercise therapy after TKA means less pain, improved physical function, and better quality of life

Published in Clinical Rehabilitation, 03/12/2013 Dr. Liao et al and team from Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan look at the effects of additional physical therapy and balance training on functional outcome after total knee replacement in patients with knee osteoarthritis (TKR).

By the year 2020, it is estimated that more than 3 million total knee arthroplasty (TKA) surgeries will be performed in the USA for end-stage arthritis in the knee joint.TKA Surgery shows rapid and substantial improvement in knee pain however 37% of patients have limited functional improvement 1 year after the surgery.

Common limitations include diminished walking speed, difficulty ascending and descending stairs.

This work follows up on work done by Dr. Riva and team from Department of Physical Therapy, University of Pittsburgh USA and published in Journal of American Physical therapy Association that also showed that additional balance training in people with TKA was supported by high exercise adherence with a relatively low dropout rate, and no adverse events.

Improvements in lower-extremity functional ability was shown by higher gait speed, single-leg stance time.

In Dr. Liao trial the control group received conventional function training for eight weeks and the experimental group received the same conventional training a +  additional balance exercises program.

Studies have shown the effectiveness of exercise therapy including range of motion, stretching, strengthening, and endurance exercises after hospital discharge. Home based and out patient exercise therapy improves the outcomes of patients after TKA including less pain, improved physical function, and better quality of life.

Main outcome measures were distance of functional forward reach; duration of single leg stance; timed sit-to-stand test; timed up-and-down stair test; timed 10-m walk; timed up-and-go test.

 

LegTutor meets goals of in-patient and out-patient rehabilitation following a Total Knee Replacement

A physical therapy programme following Total Knee Replacement will typically last 3 months and is the key compliment to ensure a successful outcome to allow the patient to regain mobility and return to a full and active lifestyle.

Compliance with the exercise programme designed to increase ROM, especially in extension and improve strength and control of the knee will therefore  improve surgery outcome.

Using the LegTutor as part of the Physical therapy – PT program will facilitate the following critical components of  pre and post sugery rehab following TKR:

■ Allows patients to better understand how to do the exercises after surgery rehab/ therapy sessions.

■ Facilitates communication with physical therapist to patient and carers by quantifying exercise performance

■ Facilitates home exercises to help gain motion and keep gains achieved in therapy by encouraging and motivating exercise practice between outpatient therapy sessions. Remember you will only meet with your therapist a few times a week after discharge

■ Encourages and motivates the patient to do customized and controlled home exercises which are important to help gain motion and keep the gains in therapy from one session to the next.

■ Allows you to better involve a friend or family member in your rehab. This is because good support system is essential for motivation and assistance throughout the recovery process.

■ Objective and quantifiable recording of exercise practice results and compliance wil allow the patient and therapist to better set goals and track progress.

Physical Rehab is the key compliment to a successful outcome post TKR and knee surgery so facilitate the exercise practice with the LegTutor.

More women than men undergo knee replacement surgery

Dr. Howard Ware, director of the Wellington Knee Surgery Unit, London is scheduled to speak at the 2nd International Congress for Joint Reconstruction – Middle East (ICJR Middle East) on the reasons behind the increase in TKR world wide.

The number of TKR iis expected to increase by 200% (USA) in the next 10 years. The reasons behind this is that are living longer and more active lives. However over all age groups, women undergoing total knee replacement is greater than men. Dr Ware is likely to reiterate that obesity is a significant factor and that more women are obese than men. In addition diet and exercise also play a significant factor in reducing this risk.

Successful Joint Replacement

joint replacement walking rehabilitation

Joint replacement surgery is indicated if chronic joint pain interferes with daily activities such as walking, exercising and working.

In the USA, over 1 million hip and knee replacement surgeries are performed each year with studies showing that joint replacement surgery can significantly relieve pain and increase mobility.

Following joint replacement therapy the rehabilitation centers objective is to return the patient to an active lifestyle as quickly as possible. In the US the national average hospital stay is 3.3 days with more than 71% of patients being back to their active lifestyles within six weeks. It is agreed by surgeons and physical therapists that early hospital discharge and the collection of data and the tracking of a  patients’ outcome is an important objective that allows patients to recover more quickly.

Rapid rehabilitation protocols include assistive technology that aims to customize the patients exercise practice to their movement ability. This is where the legTutor fits in as the device uses motion feedback to allow the patients after joint replacement surgery to do intensive exercises according to their range of motion through the use of interactive exercise games using the computer. The devices are used in the outpatient clinic and by the patient at home and can be supported by the physical therapist offering telerehabilitation.

 

Step By Step Osteoarthritis Exercise Program

Always consult with your doctor before beginning an exercise program if you have osteoarthritis.

 

Stretching the Hamstring

 Walk for 5 minutes as a warmup.  Stretch. Lie down. Put a  bed sheet around your right foot and use it to help pull and stretch your leg up. Hold that position for 20 seconds. Repeat this twice, then switch legs. There are 3  important types of exercises for knee OA. Range of motion or stretching exercises which keep you limber. Strengthening exercises which build muscle strength in order to stabilize weak joints. Aerobic exercises, like walking, which help the lung and heart.

Stretching exercises help loosen muscles and improve flexibility. They also help prevent pain and injury.

While using a chair for balance, bend your right leg then step back with your left leg, slowly straightening it behind you. Press your left heel towards the floor. You will now feel the stretch in your back leg.

If you want more of a stretch then lean forward while bending the right knee deeper. However don’t let the right knee go past your toes. Hold this position for 20 seconds. Do it twice and then switch legs.

 Straight Leg Raise

 Lie on the floor and prop your back up on your elbows. Bend your left knee while keeping your foot on the floor. Keep the right leg straight with your toes pointed up. Tighten the thigh muscles of your right leg. Smoothly and slowly  use your thigh muscles — but not your back — to raise your leg.

Pause for five seconds. While your thigh is still tight, slowly lower your leg to the ground. Relax. Repeat this 10 times. Rest. Do another 10 sets; then switch legs.

Quad Set

If the straight leg raise is too tough then do quad sets instead. With these you don’t have to raise your leg. Just tighten the thigh muscles (quadriceps) of one leg at a time.

Begin by lying on the floor keeping both legs on the ground, relaxed. Flex and hold your left leg tense for five seconds and then  relax. Do 2 sets of 10. Then, switch to the other leg.

Seated Hip March

Doing this can strengthen hips and thigh muscles to help you with daily activities, like walking or getting up  from a chair.

Sit up straight in the chair.  Kick back your left foot but keep your toes on the floor. Lift your right foot off the floor while keeping your knee bent. Hold your right leg in the air for five seconds. Slowly lower your foot to the ground. Repeat this 10 times. Then rest and do another 10 after which you should  switch legs. If this is too hard use your hands to help raise your leg.

Pillow Squeeze

This will help strengthen the inside of your legs to give support to your knee. Lie on your back with both knees bent. Put a pillow between your knees.

Squeeze your knees together, squishing the pillow between them. Hold this for five seconds then relax. Repeat the set 10 times. Rest, then do another set of 10.

If this is too hard you can  do this exercise while seated.

Heel Raise

Hold the back of a chair for support. Stand straight and tall. Lift your heels off the ground and rise up on the toes of both feet. Hold it there for five seconds. Slowly lower both heels to the ground. Repeat this 10 times then rest and do another 10.

If this is too hard do the same exercise while sitting in a chair.

Side Leg Raise

Hold the back of a chair for balance. Place your body’s weight on your left leg. Lift the right leg outwards to the side. Keep your right leg straight. Keep your outer leg muscles tensed. Try not to slouch. Lower your right leg and relax. Repeat this 10 times. Rest. Do another 10 sets, then repeat  it with your left leg.

If this is too hard increase the leg height over time. Following a few workouts, you’ll be able to raise your leg higher.

Sit to Stand

Practice this move in order to make standing easier. Put two pillows on a chair. Sit on top of them, with your back straight and feet flat on the floor. While using your leg muscles, slowly and smoothly stand up tall. Then, slowly lower yourself back down to a sitting position. Make sure your bent knees don’t move in front  of your toes. Try this also with arms crossed  or loose to your side.

If this is too hard  add pillows or use a chair with armrests and then  help push up with your arms.

One Leg Balance

Try doing this hands-free or steady yourself on a chair, if necessary. Now, shift your body weight to one leg but don’t lock your knee straight. Then slowly raise the other foot off the ground, balancing on your standing leg. Hold that for 20 seconds then lower your  raised foot to the ground. Do this twice, then switch legs. This move helps you when getting out of cars or bending.

If you find this too easy, balance for a longer time. Or do it with your eyes closed.

Step Ups

This move can help you strengthen your legs for stair climbing. Face a stable step with both feet on the ground. First, step up with your left foot then follow with your right foot. Now, stand on top, tall and while both feet are flat. Climb down in the reverse order: Right foot down first, then left. Do this 10 times then rest and  repeat another 10 times. Now do it starting with your right leg first. If this is too  hard try using a railing, wall, a lower step or lamppost for balance.

Walking

If you have  stiff or sore knees you may not think that walking is a great idea but it actually is one of the best exercises for knee arthritis. Not only  can it reduce joint pain but it can also strengthen your leg muscles and improve flexibility. It’s also good for your heart and the best part is that there are no gym membership fees needed.

Having a good form is key: Look forward, keep your arms and legs moving, relaxed and walk tall.

Low-Impact Activities

Losing weight is a side benefit of being active and exercising. It also takes pressure off your joints. Other exercises that are easy on the knees are  swimming, biking and water aerobics. Water exercise can take weight off painful joints.

It isn’t necessary to give up your favorite activities, like golf. Discuss with  your doctor or physical therapist about modifying painful moves.

How Much Exercise?

Start with just a little. If there is no pain, do more next time. Try to aim for 30 minutes a day.

In the course of time you’ll build your leg muscles which will support your knee and increase flexibility.

It is normal to have some  muscle soreness  but hurting or swollen joints should have rest. Take a break and ask your doctor for advice. Ice painful joints and take ibuprofen, naproxen  or acetaminophen as a pain reliever.

Using physical therapy solutions and products is also an effective way to strengthen leg muscles which can alleviate osteoarthritis pain. The LEGTUTOR is one such device that can be used.

 The LEGTUTOR system is a key component of physical therapy used after total knee or hip  replacement and other knee and hip surgery. The LEGTUTOR is an ergonomic wearable leg brace with dedicated rehabilitation software.  The LEGTUTOR rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. This means that the LEGTUTOR system allows the physical therapist to prescribe a leg rehabilitation program customized to the patient’s knee and hip movement ability at their stage of rehabilitation. The LEGTUTOR uses biofeedback to keep the patient motivated to do the exercise practice with those that were designed in the form of challenging games. They are suitable for a wide variety of other neurological and orthopedic injuries and diseases as well as post trauma and orthopedic surgery.

 The LEGTUTOR is also used by physical and occupational therapists in combination with the HANDTUTOR, ARMTUTOR and 3DTUTOR for upper and lower extremity rehabilitation. The TUTOR system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. It is designed for children and adults and can be used at home supported by telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

LegTutor used for post total knee surgery physical rehabilitation in Arthritis patients (RA) (OA)

Image by versageek via Flickr

”Patients with RA have lower expectations about postsurgical outcomes after TKA”. So says a new study by researchers at the Hospital for Special Surgery (HSS) in New York City published on November 6, 2011.

In a studypresented at the annual meeting of the American College of Rheumatology osteoarthritis patients compared to rheumatoid arthritis who undergo total knee replacement (TKR) surgery have lower expectations about their postsurgical outcomes. This can cause some patients is the OA group to reduce their postsurgical rehabilitation leading to worse outcomes.

Lisa Mandl from the hospitla said that if patients have lower expectations, then maybe they don’t push themselves during their physical therapy.

It is well reported that rheumatoid arthritis (RA) who undergo a TKR – total knee replacement are often very satisfied with the surgery. This is contrary to the inferior outomes that RA patiens show compared to OA. Because satisfaction is not only determined by reduction is  in pain but also the meeting of  pre-operative expectations, investigators looked to determine if the expectations of the two patient groups differed. TKR is also known as  total knee arthroplasty. Roughly 90 percent of patients who undergo TKA have osteoarthritis.

The outcome measures that the group used where:

Lower Extremity Activity Score (LEAS) score.

Pain, stiffness and function prior to surgery, can be measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC).

Expectations prior to surgery measured using the Hospital for Special Surgery Expectations Survey

Intensive exercise practice is proven to improve functional movement ability following orthopedic and neurological injury and disease including post TKR, TKA and THR, THA. Patient motivation and control of the exercise practice are the fundamental factors that are required for optimum functional recovery. Traditional practice is mostly based on low technology tools that intrinsically lack features to challenge and motivate the patient to intensive exercise training. In addition low technology tools do not provide sufficient resolution that allow the physical and occupational therapist to completely control the required exercise performance.

 The Tutor system, consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor, has been developed to allow for functional rehabilitation of the whole body including the upper and lower extremity. The Tutors consist of ergonomic wearable devices and dedicated rehabilitation software that provide patient instructions and feedback to encourage intensive massed controlled exercise practice after TKR and THR and other knee and hip surgery. The Tutor system allows for controlled exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. For instance when the patient following TKR does a squat exercise the knee may rotate inwards. In this case the physical therapist using the LegTutor will encourage the patient to do repetitive squatting exercises that do not have compensatory knee rotation. During the practice the physiotherapist and the patient is provided with biofeedback information on the rotation of the knee. In this way, the patient will learn how to do the exercise and properly strengthen the knee without the accompanying knee rotation.  Additional features of the Tutor system include quantitative evaluation, objective follow up and tele-rehabilitation.

 The new medical devices are available for children as well as adults and through the use of telerehabilitation and are FDA and CE certified.

http://www.handtutor.com

The Tutor System Maintains Current Strength in Osteoarthritis Patients

Image by Old Shoe Woman via Flickr

Susan Hill et al in a study for Disability and Rehabilitation,  December 2011 discuss a study whose purpose is to describe. Osteoarthritis (OA) as the commonest reason for a musculoskeletal consultation in primary care in older adults. There is evidence that appropriate advice and management is sub-optimal. The aim of this study was to explore perceptions and experiences of the treatment and management of hand OA in older adults.

The methods used in the study were four focus groups who were conducted with primary (n === 15) and secondary (n === 14) care participants aged 50-84 years (mean age 64.9 years; 3 males, 14 females) with a clinical diagnosis of hand OA. Data were tape-recorded, transcribed and analysed using thematic analysis and constant comparison method.

The results showed that participants described a lack of help and information with regards to management of their hand OA and also a perceived lack of understanding of the impact of hand OA on the individual. Some received contradictory advice about its management. Beliefs about treatment efficacy were balanced against perceived and actual side-effects and tolerance, and such perceptions appeared to influence the use of alternative therapies.

The conclusions reached were that the study identified a perceived unmet need in people with hand OA presenting in primary and secondary care. This may be due to the clinical uncertainty of treatment, lack of high-quality randomised controlled trials evaluating therapeutic options, and the limited written information available incorporating the patient experience. The study emphasised the need to understand patient illness and treatment beliefs. A better understanding of illness and treatment beliefs will facilitate the use of evidence-based approaches in the management of hand OA.

The Tutor devices provide for interactive rehabilitation exercises and can alleviate some of the shoulder and other joint pain.

The Tutor system, consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor, has been developed to allow for functional rehabilitation of the whole body including the upper and lower extremity. The system consists of ergonomic wearable devices and dedicated rehabilitation software that provide patient instructions and feedback to encourage intensive massed controlled exercise practice. The Tutor system allows for controlled exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. Additional features of the Tutor system include quantitative evaluation, objective follow up and tele-rehabilitation.

The new medical devices are available for children as well as adults and through the use of telerehabilitation and are FDA and CE certified.

LegTutor Enhances Range of Motion for Knee Replacement Patients

Image by Fouquier via Flickr

Pazit Levinger et al conducted a study published in  Springer Link in October 2011.

The purpose of the study was to determine why knee pain and disability still persists following knee replacement surgery (TKR) which will place patients at increased risk of falls. This study looked at the falls risk and the occurrence of falls of people with knee osteoarthritis (OA) before and at 12 months following knee replacement surgery.

The method used in the study was:

Thirty-five patients with knee OA were tested using Physiological Profile Assessment both prior to undergoing knee replacement surgery and also at 12 months following surgery. The Physiological Profile Assessment  is an outcome measure that looks at vision, lower limb proprioception, knee extension strength, reaction time and postural sway. Other outcome measures included Physical activity, number of falls, fear of falling, pain, disability and health-related quality of life were also assessed.

The results  found no significant differences between no’ of falls pre- and post-surgery with 48.5% compared to 40% reporting at least one fall in the 12 months before and following the surgery. Improvement in knee strength/ reaction time/ fear of a fall were seen following surgery. There was no improvement in lower limb proprioception. Self-reported pain, function and stiffness did  significantly improve, but health-related quality of life (HRQOL) deteriorated following the surgery.

The group concluded that persistence of impaired lower limb proprioception may have contributed to the number of falls experienced following knee replacement surgery. In addition, although knee replacement surgery(TKR) improves function and alleviates pain, patients post TKR may need to engage in proprioception rehabilitation following the surgery to reduce the risk of falling.

The LegTutor has shown remarkable success in post knee replacement surgery. The LegTutor™ system has been developed to allow for functional rehabilitation of the lower extremity. Together with the 3DTutor the LegTutor can be used to increase the patients proprioception performance with dedicated games being developed in the rehabilitation software for this outcome. The Tutor system rehabilitation concept, which includes the HandTutor, ArmTutor and 3DTutor, is based on performing controlled exercise rehabilitation practice at a patient customized level including balance and proprioception training. This is achieved with real time accurate feedback on the patient’s performance.  The exercises are designed in the form of challenging rehabilitation games that are suitable for a wide variety of neurological and orthopedic injury and disease. The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice. Exercise practice is the most important manual therapy tool in the armory of physical and occupational therapists to ensure optimal rehabilitation.

The LegTutor™ allows for isolated and a combination of knee and three directional hip treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multi joints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.

The LegTutor™ system is used by many leading rehabilitation centers worldwide for both neurological and orthopedic patients including adults and children. the Tutor system holds FDA and CE certification.

http://www.handtutor.com