Hip

Case Studies supporting PEMF benefits for Hip

Peri-operative interventions producing better functional outcomes and enhanced recovery following total hip and knee arthroplasty: an evidence-based review

Abstract

The increasing numbers of patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA), combined with the rapidly growing repertoire of surgical techniques and interventions available have put considerable pressure on surgeons and other healthcare professionals to produce excellent results with early functional recovery and short hospital stays. The current economic climate and the restricted healthcare budgets further necessitate brief hospitalization while minimizing costs. Clinical pathways and protocols introduced to achieve these goals include a variety of peri-operative interventions to fulfill patient expectations and achieve the desired outcomes. In this review, we present an evidence-based summary of common interventions available to achieve enhanced recovery, reduce hospital stay, and improve functional outcomes following THA and TKA. It covers pre-operative patient education and nutrition, pre-emptive analgesia, neuromuscular electrical stimulation, pulsed electromagnetic fields, peri-operative rehabilitation, modern wound dressings, standard surgical techniques, minimally invasive surgery, and fast-track arthroplasty units.



Background: Joint arthroplasty is a surgical procedure performed to reduce pain, improve function, and correct deformity [1]. Hip and knee arthroplasties have been found to be very effective in improving health-related quality of life [2]. Joint arthroplasty is becoming increasingly common as the population ages and clinical researchers advance medical knowledge. The full number of total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures performed annually in the UK has increased steadily over the past decade [3]. The annual report of the National Joint Registry showed that 71,672 primary hip replacement procedures and 79,516 primary knee replacements were undertaken in 2011 [4]. A similar rise in the incidence of these procedures was noted worldwide [2]. Use of total knee arthroplasty in the USA doubled from 1999 to 2008, and this increase was noticed in all age groups [5]. This rise cannot be fully explained by population growth and the obesity epidemic alone, and is probably related to the increasing incidence of sports-related knee injuries and the expanded indications for TKR [5]. Early functional recovery and discharge from hospital are important to surgeons, patients, and health administrators. The current economic climate and restricted healthcare budgets represent additional hurdles. In 2004, Berend et al. found that adopting a holistic peri-operative rapid-recovery program reduced inpatient stays and readmissions following THA and TKA. However, the authors reviewed only non-operative measures, and concluded that these can be effective in speeding recovery. They suggested combining these measures with minimally invasive surgery to achieve the best possible outcomes and faster recovery [6]. The aim of this review is to provide an evidence-based summary of measures, interventions, and procedures (both surgical and non-surgical) that help to achieve early functional recovery, reduce hospital stay, and improve functional outcome following THA and TKA.

Case Study Reference Source:

  • 1. Peri-operative interventions producing better functional outcomes and enhanced recovery following total hip and knee arthroplasty: an evidence-based review
    (Authors: Mazin S Ibrahim, Muhammad A Khan, Ikram Nizam and Fares S Haddad)