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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
A Journal on Physical Medicine and Rehabilitation after Pathological Events
Official Journal of the , , , ,
In association with
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Europa Medicophysica 2003 March;39(1):45-57
The individual rehabilitation project in hip arthroplasty patients
Rucco V., Visentini A., Pellegrini E.
Rehabilitation Unit Ospedale di Spilimbergo (Pordenone), Italy
In orthopaedic surgery, hip arthroplasty is today one of the most frequent elective (and not emergency) operations. Recreation of the correct anatomical relationships that for years had been compromised by the arthritic disease is, however, only the 1st step towards complete recovery of good functionality of the new joint. Such recovery is the result of a correct approach to rehabilitation, which must take into account the various problems emerging after surgery and thus, even in cases of a single disability (as the outcome of hip replacement surgery) the commitment of the rehabilitation team may be considerable. This is particularly true in recent years because, thanks to improvements in surgical techniques, hip arthroplasty is now also performed in patients suffering from complex disabilities (hemi-plegia, Parkinson’s disease, etc.) or from other medical conditions (atrial fibrillation, history of pulmonary embolism, etc.). This review aims to determine the problems that are encountered in formulating an rehabilitation project for hip arthroplasty patients. Determination of the rehabilitation diagnosis is the 1st step in defining the individual rehabilitation project, and is very different from the disease diagnosis formulated by specialists in wards for acute patients. The rehabilitation diagnosis must take several factors into account: some pre-existent to surgery (and for which the pre-surgical evaluation is important), others that are a direct consequence of surgery, and others again that present as complications in the days, months or years subsequent to surgery (and that need careful monitoring by the rehabilitation team). To formulate a rehabilitation prognosis means to know in advance the theoretical improvement that is possible for a disability (and thus the outcome that theoretically might be achieved in the patient operated for hip replacement and the average time required to achieve it) and to determine the actual improvement that can be achieved in the patient in question (and thus the outcome that the specific patient may actually achieve). The real capability for improvement may be significantly reduced by the co-existence of other disabilities or diseases. Therapeutic-rehabilitation-occupational programmes are tailored to the various emerging disabilities found, and in their turn are influenced by pre-existing disabilities and medical problems. For each programme the rehabilitation team must agree on evaluation modalities (to be applied before and after treatment), short-term goals (approximately 2 weeks), the tools to be used to reach these goals (pharmacological, rehabilitation, infiltration, etc.). Correct determination of the most suitable rehabilitation pathway enables a more rational use of the network of rehabilitation structures available within the health service, ensuring at the same time maximum protection for the patient. Determination of the rehabilitation pathway depends on 3 basic parameters: the medical requirement (which is proportionate to the patient’s clinical-internal-medicine stability and to the degree of complexity of the disability), the care requirement (which is proportionate to the patient’s need for nursing care) and the residential requirement (proportional to the patient’s social needs). Furthermore, since the future of the total hip arthroplasty patient will be subject to numerous complications, the rehabilitation team (physiatrist, physiotherapist, nurse) must organise periodic check-ups, understand the various problems that exist, be properly trained and work in close collaboration, in order to avoid late diagnoses and unsuitable or indeed completely useless treatment. Lastly, it should not be forgotten that, in evaluating the results of prosthetic surgery, other factors that are not directly linked to the surgery itself play a role: patient satisfaction is increased if the operation occurs after a long period of disease compared to patients operated after a short period of disease. Furthermore, acceptance of possible side-effects and consequent irreversible disabilities of varying degrees of severity is greater in the former group of patients.