OncologyEver Shorter Hospital Stays After Orthopaedic Operations Present A Major Challenge To Rehabilitation - Pre-operative Training Can Improve Results
"Rehabilitation medicine is facing a major challenge today," says Dr. Karsten Dreinh̦fer (Head of Department for Orthopaedics and Orthopaedic Surgery, Medical Park Berlin Humboldtm̿hle, Germany) speaking at the EFORT Congress in Vienna. "Not only in Germany but in many other European countries too, the trend is towards the shortest possible stay in an acute hospital after orthopaedic or trauma-related surgery. This means patient care is shifting increasingly to the rehabilitation sector, which must then be appropriately equipped and trained." But demographic developments are also presenting a significant challenge to orthopaedic rehabilitation: with modern surgical procedures, surgery such as joint replacement operations can be carried out on more and more patients, including the elderly and the very elderly, who then require special care and mobilization assistance, says Dr. Dreinh̦fer, who has been appointed to the professorship for musculoskeletal rehabilitation, prevention and health care research at the Charit̩ in Berlin. Broad interdisciplinary cooperation is also necessary, he says. "Multimodal concepts have proven to be especially effective in numerous diseases of the musculoskeletal system," says Dr. Dreinh̦fer, speaking of a further important trend. "This involves orthopaedics working together with other disciplines, such as physiotherapy, psychotherapy and sports sciences, to be able to help effectively such common complaints as back pain." He says it is also important to cooperate across various health sectors. "It is increasingly important to optimise, via treatment pathways, the transition from the pre-inpatient sector, to acute care and to rehabilitation."
The Congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT), which is being held from 3 to 6 June, 2009, has brought together over 8,000 participants from around the world. International experts are presenting current trends and important developments from all areas of orthopaedics, with much attention paid to the theme of rehabilitation.
Orthopaedic surgical procedures are constantly improving in quality and range - but after the replacement of a knee or hip joint the patient must learn again to move correctly. A series of current studies have investigated the importance of physical training in this connection.
Training before an operation improves resilience afterwards
Systematic training before an operation can contribute significantly to the success of an orthopaedic procedure, as a new study from Ireland being presented at the EFORT Congress demonstrates. Dr. Gavin McHugh (Dublin) and his team compared the success of rehabilitation of patients who underwent knee joint replacement surgery. One group took part before the operation in a six week special training programme which strengthened the leg musculature. After the operation both groups received standard physiotherapy. Categories such as muscle strength, knee function and the structure of muscle were then measured. The group which underwent training scored better in all categories than the control group. "We were able to demonstrate for the first time in this study that a pre-operative training programme for patients receiving a knee endoprosthesis has advantages for post-operative mobility and resilience," say the study authors.
Hip prosthesis: Patients maintain physical activity after revision
An investigation by a Dutch group, which is being presented at the EFORT Congress in Vienna, looks at the post-operative physical activity of hip replacement patients. Dr. Martin Stevens (Groningen, The Netherlands) and his team compared patients after a so-called revision - a second operation when for instance a prosthesis has become loose - with those who had received an artificial hip for the first time. One of the surprising results from a survey of 506 patients: although more patients complained of significant physical limitations after a second operation, physical activity was at a comparable level between the two groups. Thus to assess success of rehabilitation, many diverse aspects need to be taken into account, say the study authors.
Patients should be motivated to be more active
In general, hip replacement patients should be motivated to be more physically active after an operation, as another study shows, which is presented in Vienna by the same research team from The Netherlands. Dr Stevens and his colleagues also examined sports activities of patients with artificial hips. The younger the patient and the lower the Body Mass Index, the more active they are, the survey shows. On average, those who had had hip operations engaged in around 1,500 minutes of exercise a week. "That is in fact the level of the general population," the study authors say. "However a high proportion of patients is not active enough, we should motivate them to exercise more."
Abstracts:
EFORT 2009 Abstract: McHugh G et al, Pre-operative exercise enhances strength, function and muscle structure post TKA. A randomized trial.
EFORT 2009 Abstract: Stevens M et al, Self reported limitations and physical activity after revision of hip surgery: A comparison with primary hip surgery
EFORT 2009 Abstract: Stevens M et al, Physical activity behavior of patients one year after primary total hip arthroplasty
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