UK survey of occupational therapist’s and physiotherapist’s experiences and attitudes towards hip replacement precautions and equipment

Background: Total hip replacement (THR) is one of the most common orthopaedic procedures in the United Kingdom (UK). Historically, people following THR have been provided with hip precautions and equipment such as: raised toilet seats and furniture rises, in order to reduce the risks of dislocation post-operation. The purpose of this study was to determine current practices in the provision of these interventions in the UK for people following primary THR. Methods: A 27-question, self-administered online survey was developed and distributed to UK physiotherapists and occupational therapists involved in the management of people following primary THR (target respondents). The survey included questions regarding the current practices in the provision of equipment and hip precautions for THR patients, and physiotherapist’s and occupational therapist’s attitudes towards these practices. The survey was disseminated through print and web-based/social media channels. Results: 170 health professionals (87 physiotherapists and 83 occupational therapists), responded to the survey. Commonly prescribed equipment in respondent’s health trusts were raised toilet seats (95%), toilet frames and rails (88%), furniture raises (79%), helping hands/grabbers (77%), perching stools (75%) and long-handled shoe horns (75%). Hip precautions were routinely prescribed by 97% of respondents. Hip precautions were most frequently taught in a pre-operative group (52% of respondents). Similarly equipment was most frequently provided pre-operatively (61% respondents), and most commonly by occupational therapists (74% respondents). There was variability in the advice provided on the duration of hip precautions and equipment from up to six weeks post-operatively to life-time usage. Conclusions: Current practice on hip precautions and provision of equipment is not full representative of clinician’s perceptions of best care after THR. Future research is warranted to determine whether and to whom hip precautions and equipment should be prescribed post-THR as opposed to the current ‘blanket’ provision of equipment and movement restriction provided in UK practice

Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty

<p>Abstract</p> <p>Background</p> <p>Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty.</p> <p>Although research suggests that Continuous Passive Motion (CPM) should be implemented in the first rehabilitation phase after surgery, there is substantial debate about the duration of each session and the total period of CPM application. A Cochrane review on this topic concluded that short-term use of CPM leads to greater short-term range of motion. It also suggested, however, that future research should concentrate on the treatment period during which CPM should be administered.</p> <p>Methods</p> <p>In a randomised controlled trial we investigated the effectiveness of prolonged CPM use in the home situation as an adjunct to standardised PT. Efficacy was assessed in terms of faster improvements in range of motion (RoM) and functional recovery, measured at the end of the active treatment period, 17 days after surgery.</p> <p>Sixty patients with knee osteoarthritis undergoing TKA and experiencing early postoperative flexion impairment were randomised over two treatment groups. The experimental group received CPM + PT for 17 consecutive days after surgery, whereas the usual care group received the same treatment during the in-hospital phase (i.e. about four days), followed by PT alone (usual care) in the first two weeks after hospital discharge.</p> <p>From 18 days to three months after surgery, both groups received standardised PT. The primary focus of rehabilitation was functional recovery (e.g. ambulation) and regaining RoM in the knee.</p> <p>Results</p> <p>Prolonged use of CPM slightly improved short-term RoM in patients with limited RoM at the time of discharge after total knee arthroplasty when added to a semi-standard PT programme. Assessment at 6 weeks and three months after surgery found no long-term effects of this intervention Neither did we detect functional benefits of the improved RoM at any of the outcome assessments.</p> <p>Conclusion</p> <p>Although results indicate that prolonged CPM use might have a small short-term effect on RoM, routine use of prolonged CPM in patients with limited RoM at hospital discharge should be reconsidered, since neither long-term effects nor transfer to better functional performance was detected.</p> <p>Trial Registration</p> <p>ISRCTN85759656</p

Immediate recovery room radiographs after primary total knee arthroplasty—why do we keep doing them?

Recovery room radiographs (RRR) are routinely performed after total knee arthroplasty (TKA). This study investigates the utility of these radiographs. Twenty four arthroplasty surgeons were surveyed to rank the value of RRRs. Since RRRs were primarily valued for educational purposes, we examined the ability of 49 orthopaedic trainees to determine the coronal alignment of TKA performed in cadaveric specimens based on these radiographs in neutral, 10° internal and external rotations. Surgeons rated the quality of the RRRs to be significantly lower than the radiographs taken in the radiology suite (5.5 ± 2.5 versus 8.9 ± 0.9, p < 0.0001). Of an estimated 65,910 TKAs performed by these surgeons, only eight cases (0.01%) required same day revision based on the RRR. Neutral alignment was significantly more accurately (p < 0.0001) interpreted than valgus or varus (69.4% versus 42.9% and 16.3%, respectively). Surprisingly, internal rotation of the limb significantly improved interpretation of both varus (from 16.3% to 40.8%, p = 0.014) and valgus (from 42.9% to 63.3%, p = 0.048). Increased level of orthopaedic training did not significantly affect the accuracy of interpretation (p = 0.46). Interpretation of RRRs for coronal malalignment is inaccurate and has a limited educational value

Clinical value of regular passive ROM exercise by a physical therapist after total knee arthroplasty

Regular passive ROM exercise (PROME) by a physical therapist is often incorporated in rehabilitation protocols after total knee arthroplasty (TKA). This randomized, controlled trial examined whether or not the incorporation of PROME to a postoperative rehabilitation protocol would offer a better clinical outcome after TKA. Fifty consecutive patients who underwent bilateral TKAs staged 2 weeks apart received PROME for one knee and not for the other. The pain level (7D and 14D), patient`s preference (before discharge, 6M), maximum flexion (7D, 14D, 3M, 6M) and American Knee Society and WOMAC scores (6M) were determined in the knees with and without PROME and compared. There were no significant differences in the maximum flexion, pain level, patient`s preference, AKS scores and WOMAC scores. This study demonstrates that the incorporation of PROME does not offer additional clinical benefits to the patients after TKA. Our findings may suggest that encouraging patients to perform active ROM exercise would be a better option and that a physiotherapy session by a physical therapist can focus on more functional rehabilitation, such as preparing to return to daily activities.Chang CB, 2007, J BONE JOINT SURG BR, V89B, P1324, DOI 10.1302/0301-620X.89B10.19120Park KK, 2007, CLIN ORTHOP RELAT R, P143, DOI 10.1097/BLO.0b013e31804ea0bcRestrepo C, 2007, J BONE JOINT SURG AM, V89A, P1220Park KK, 2007, J BONE JOINT SURG BR, V89B, P604, DOI 10.1302/0301-620X.89B5.18117Bin SI, 2007, KNEE SURG SPORT TR A, V15, P350, DOI 10.1007/s00167-006-0202-yHan I, 2007, KNEE SURG SPORT TR A, V15, P372, DOI 10.1007/s00167-006-0190-yDenis M, 2006, PHYS THER, V86, P174Crowninshield RD, 2006, CLIN ORTHOP RELAT R, P266, DOI 10.1097/01.blo.0000188066.01833.4fBohannon RW, 2005, CLIN REHABIL, V19, P662, DOI 10.1191/0269215505cr873oaHuang HT, 2005, J ARTHROPLASTY, V20, P674, DOI 10.1016/j.arth.2004.09.053Kim YH, 2005, J BONE JOINT SURG AM, V87A, P1470, DOI 10.2106/JBJS.D.02707SEON JK, 2005, ORTHOPEDICS, V28, P1247Argenson JNA, 2004, CLIN ORTHOP RELAT R, P174, DOI 10.1097/01.blo.0000148948.79128.76Rajan RA, 2004, ACTA ORTHOP SCAND, V75, P71Kramer JF, 2003, CLIN ORTHOP RELAT R, P225, DOI 10.1097/01.blo.0000063600.67412.11SULLIVAN MG, 2003, ADULT KNEE, V1, P455LI G, 2003, ADULT KNEE, V2, P1233Weiss JM, 2002, CLIN ORTHOP RELAT R, P172, DOI 10.1097/01.blo.0000036536.46246.d9Kurosaka M, 2002, J ARTHROPLASTY, V17, P59, DOI 10.1054/arth.2002.32688Mulholland SJ, 2001, INT J REHABIL RES, V24, P191Akagi M, 2000, J BONE JOINT SURG AM, V82A, P1626MacDonald SJ, 2000, CLIN ORTHOP RELAT R, P30Chen BQ, 2000, AM J PHYS MED REHAB, V79, P421Mahomed NN, 2000, J RHEUMATOL, V27, P1753Worland RL, 1998, J ARTHROPLASTY, V13, P784Yashar AA, 1997, CLIN ORTHOP RELAT R, P38Pope RO, 1997, J BONE JOINT SURG BR, V79B, P914Kumar PJ, 1996, CLIN ORTHOP RELAT R, P93Montgomery F, 1996, ACTA ORTHOP SCAND, V67, P7VERVERELI PA, 1995, CLIN ORTHOP RELAT R, P208KIM JM, 1995, CLIN ORTHOP RELAT R, P177MALONEY WJ, 1990, CLIN ORTHOP RELAT R, P162DUPONT WD, 1990, CONTROL CLIN TRIALS, V11, P116INSALL JN, 1989, CLIN ORTHOP RELAT R, P13RITTER MA, 1989, CLIN ORTHOP RELAT R, P239BELLAMY N, 1988, J RHEUMATOL, V15, P1833