If you or a loved one has undergone or are considering knee or hip replacement, post operative rehabilitative therapy is an important consideration. Based on specific criteria, you may meet guidelines to receive your therapy as an inpatient. Otherwise, your postoperative rehabilitative care will most likely be on an outpatient basis at a facility convenient to your home.
Consideraitons
Rehabilitation criteria can differ based on your insurance carrier and the hospital where you choose to receive care. For example, Spaulding Rehabilitation Hospital in East Sandwich, Massachusetts, uses specific guidelines to determine whether you will receive therapy as an inpatient or an outpatient. If you have surgery to replace both knees or hips at the same time, or if you fracture your hip and need a replacement joint, you meet criteria to be admitted for inpatient rehabilitation treatment. If you are obese with a body mass index, or BMI, greater than 50 for single or double joint replacement, you also quality for inpatient rehab. Finally, if you are 85 years or older or have a coexisting medical problem such as Parkinson's disease, multiple sclerosis or a history of stroke, you meet the guidelines for inpatient rehab treatment. If you do not fall within these parameters, your care at Spaulding will be on an outpatient basis.
Goals
The three main goals of rehabilitation include prevention of postoperative complications, restoration of joint function and the reduction of pain. Your rehabilitation, whether inpatient or outpatient based, will include a treatment plan specifically designed for you based on your pre-operative functional condition and any concomitant medical conditions you may have. The physicians who specialize in rehabilitation treatment are called physiatrists or physical medicine experts. They will create a treatment plan for your care and work with the nurses and therapists to see that you meet those goals.
Exercises
The American Academy or Orthopaedic Surgeons provides guidelines for early post operative exercises specifically for hip replacements. These exercises are also useful if you have had your knee replaced. The AAOS suggests 20 to 30 minutes of early postoperative exercise two to three times per day. You will be helped and guided by your surgeon and physical therapist while you are still in the hospital. Some of the exercises you may do will likely include ankle pumps and rotations, knee bends while in bed, supine buttock contractions, leg abduction and quadriceps exercises. Your doctor and therapist will create a special program to meet your specific requirements.
Facilities
If you qualify for inpatient rehabilitation, once you recover from your surgery you will be moved to an inpatient rehabilitation facility. Some acute care hospitals have rehab on campus, but often you will be moved to a completely different building. If you continue rehab as an outpatient, you will work with your surgeon to choose a facility. It is likely that the arrangements for therapy will be made prior to your surgery. Be sure to explore the admission guidelines at the center where you are considering rehabilitation prior to surgery. Also, call your insurance carrier to determine its reimbursement policies for your rehabilitative treatment.
