Costs of Hip and Knee replacement – THA/ TKA
According to the IFHP – International Federation of Health Plans, the U.S. average for all hospital and physician costs including in patient and out patient Physical therapy was $40,364 for hip replacement and $25,637 for knee replacement. The next most expensive country was Australia with a cost of $27,810 for hip replacement and $22,421 for knee replacement.
Writing in Journal of Knee Surgery, 03/21/2013 Dr. Issa K et al. brings clarity to the question of whether Obesity affects the outcomes of Primary Total Knee Arthroplasty Replacement (TKR).
The group compared clinical and radiographic outcomes of primary total knee arthroplasty (TKA) in both obese and non obese patients and found no differences in the length of hospital stay for the two groups at early to mid–term follow–up. However the authors from the Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Maryland USA and the Department of Orthopaedic Surgery, Beth Israel Medical Center, New York, USA encourage all patients to lose weight prior to their TKA.
Another study by Chin Tat Lim, MD in Singapore using outcome measures of TKR: Knee Society Score (KSS), Short Form 36 Health Survey (SF36) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) outcomes have shown that although non-obese (according to BMI) patients achieved “superior” post-operative flexion and range of movement there is no difference is outcome for obese and non obese patietns at 2 years.
“Obesity does not negate good surgical outcome in total knee arthroplasty,” said lead study author
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.
Dr. Mark P. Figgie Chief of the Surgical Arthritis Service at Hospital for Special Surgery New York, NY USA will present his findings on Total Knee Replacement in Juvenile Idiopathic Arthritis at the annual meeting of the American Academy of Orthopedic Surgeons – AAOS in Chicago. His research study entitled “Total Knee Arthroplasty in Patients with Juvenile Idiopathic Arthritis: A Multi-Center Study, shows that 92 percent of implants lasts at least 10 yrs compared to at least 20 yrs in adults.
The orthopedic surgeon said that Joint replacement can in JIA patients can free patients, many of them adolescents, from a life of unrelenting pain. This means functionally that it can enable those in a wheel chair to walk again.
José A Rodriguez, director of the Center for Joint Preservation and Reconstruction at Lenox Hill Hospital in New York will present these findings at annual meeting of the American Academy of Orthopedic Surgeons – AAOS in Chicago.His research shows that in 90% of patients surveyed who underwent THR or TKR or - total hip or total knee replacement reported improvement.
His findings from a postoperative survey six months after surgery suggest that sexual function needs to be discussed with patients during routine evaluations.
The numbers of knee replacements in the US stands at 658,340 per year and the number of hip implants at 302,839.
Writing in European Journal of Trauma and Emergency Surgery, 03/18/2013 Dr. Leitgeb J et al. from the Department of Traumatology Anaesthesiology and Intensive Care Medicine, Trauma Hospital ‘‘Lorenz Boehler’’, Vienna, Austria and the Medical University of Vienna discuss the association between score in the Glasgow Coma Scale (GCS) at intensive care unit (ICU) discharge and the 1–year outcome of patients with severe traumatic brain injury (TBI). The group show that patients with a GCS score <10 at ICU discharge will have a poor chance of achieving a favourable outcome.
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.
Published in BMC Musculoskeletal Disorders 03/13/2013 Dr. Okoro T et al from Department of Orthopaedics and Physiotherapy Bangor University, Bangor, UK look at ’standard’ rehabilitation care in the UK after total hip replacement (THR). Because Total hip replacement (THR) is one of the most widely performed procedures in orthopaedic practice with the number of primary total hip replacements (THR) over 79413 in the UK (according to the National joint registry) undergoing THR. This number will increase with the rising age of the population.
THR for patients with end stage joint disease is shown to give pain relief, and substantial improvement in quality of life. However studies show that, even in the absence of pain, there is still movement impairments and functional limitation in post surgery patients including reduced muscle strength, reduced postural stability, and limited flexibility. These impairments cause functional limitations including reduced walking speed, and less functional ability. The group present evidence of prolonged poor function in patients following total hip replacement (THR) in the UK. Patients with poor functional outcome measures 2 years post-operatively after THR are five times more likely to require assistance with ADLs compared to those who have good function. Therefore it is important to avoid long-term impairment and to optimise functional recovery.
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.
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.