Setting of physical therapy after total hip, knee arthroplasty can be controversial
PARK CITY, Utah — Following total hip or knee arthroplasty, inpatient physical therapy is not better than outpatient physical therapy and outpatient physical therapy is not better than home-based physical therapy, according to Rafael J. Sierra, MD, who based those statements on a review of the literature he discussed at the Joint Arthroplasty Mountain Meeting.
“Is outpatient physical therapy better than web-based and tele-rehab? The answer to that is no,” he said, noting a study by Klement and colleagues showed about 65% of patients undergoing total knee arthroplasty benefitted from a web-based physical therapy tool.
“However, not all patients adhere to a web-based program; but it is a good option for many patients,” he said.
Each setting for physical therapy has advantages and disadvantages, according to Sierra. For example, hospital-based physical therapy may be associated with better pain control, he said.
Although patients like supervised, formal outpatient therapy and it provides them with immediate feedback, “there are, however, some marked disadvantages of formal outpatient therapy, most important related to costs,” Sierra said. “We look at the costs to Medicare patients in 2009; $180 million were spent on outpatient therapy.”
Other drawbacks include the time commitment and possible issues with transportation to outpatient therapy appointments.
A drawback to web-based physical therapy is that patients with more comorbidities may not be able to manage a physical therapy program delivered that way, he said.
“There’s no doubt, and that data is inclusive, that physical therapy increases in hips, abductor strength, gait speed, functional quality of life measures and mobility for our patients. For total knee arthroplasty patients, the data shows that it does improve range of motion. Physical therapy definitely helps our patients,” said Sierra. “So, physical therapy is not really controversial. I know all of us use it one way or the other. What is controversial is what is the best way to deliver physical therapy to our patients.”
Sierra’s approach is not ordering formal physical therapy for his patients. Instead, for most of them, he recommends self-directed physical therapy.
“For some outpatient joints, it is important that you instruct these patients ahead of time. If patients do not get to a certain range of motion at 2 weeks, ... I do recommend outpatient therapy, mainly because I can get feedback from the therapist,” Sierra said. – by Susan M. Rapp
Reference s :
Klement MR, et al. J Arthroplasty. 2018;doi:10.1016/j.arth.2018.11.040. [Epub ahead of print].
Sierra RJ. Is formal PT needed for the postoperative TKA and THA patient? Presented at: Joint Arthroplasty Mountain Meeting; Feb. 10-13, 2019; Park City, Utah.
Disclosure: Sierra reports no relevant financial disclosures.