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| |  Earlier Rehab For Hip And Knee Surgery May Speed Recovery CHICAGO, IL -- March 17, 1998 -- High-risk patients who have hip or knee replacement surgery can speed up their recovery process by beginning intensive rehabilitation three days after surgery instead of seven, according to an article in tomorrow’s issue of The Journal of the American Medical Association. Michael Munin, M.D., and colleagues from the University of Pittsburgh, PA., monitored 71 high-risk patients undergoing elective hip or knee arthroplasty (replacement of a joint or part of a joint by metal or plastic components). High-risk patients included: those over age 70 who were living alone; those over age 70 who had two or more comorbid conditions; and those of any age with three or more comorbid conditions. A checklist of 11 comorbid conditions included diabetes requiring medication, coronary artery disease, asthma requiring medication and cancer. The researchers found that the group that began rehabilitation three days after surgery had an average length of hospital stay of about 12 days and that the group that began rehabilitation seven days after surgery had a stay of about 14 days. "The results from this randomized trial indicate that high-risk individuals undergoing elective hip and knee arthroplasty had shorter total length of stay, faster attainment of short-term functional milestones and equivalent functional outcome at four-month follow-up if they completed an inpatient rehabilitation program that began on the third rather than the seventh postoperative day," the authors write. Total costs for the day-three group averaged about $25,891, compared to $27,762 for the day-seven group. The day-three group also demonstrated longer ambulation distance walked and superior functional independence for mobility and selfcare during postoperative days six to eleven. According to the authors, total joint replacements for the hip and knee are among the most common surgical procedures in the U.S. Rehabilitation is essential to minimize disability after surgery, yet pressure on clinicians to reduce length of stay has limited the use of hospital rehabilitation services. Most patients can be discharged directly home in five to seven days if they are medically stable and have completed a postoperative rehabilitation program.
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