[Flexible rehabilitation times after total hip and knee replacement].
BACKGROUND
In the literature, many studies have focussed on the efficacy of individual rehabilitative treatments and therapies, whereas the duration of the rehabilitation after uncomplicated total alloarthoplastic hip and knee replacement in a previously known Cox and gonarthrosis is rarely mentioned. Therefore, the purpose of the present study was to analyze the duration of inpatient medical follow-up treatment.


METHODS
In the present prospective study, 127 patients with uncomplicated total hip replacement (THR) and 110 patients with total knee replacement (TKR) implantation caused by advanced Cox or gonarthrosis were postoperatively examined. In this study only patients with the health insurance AOK Rheinland/Hamburg were included. To detect the degree of mobility of the patients, the Staffelstein score was used. It was measured at admission of the patient (T1) and afterwards at the weekly follow-ups (T2-T4), and on the day of discharge (T5). For a better assessment of the necessary individual period of rehabilitation, a target number of points was specified in the Staffelstein score whose achievement was defined as a rehabilitation aim. On the day of admission and in the following weeks of rehabilitation, the degree of mobility was recorded and evaluated in order to adapt the rehabilitation period to the individual situation of each patient.


RESULTS
The study showed that the highest rehabilitation progress associated with a significant improvement of mobility degree has been achieved in both THR and TKR patients at the end of the second week of rehabilitation (T2-T3). In the Staffelstein score, 45 % of THR patients and 44 % of TKR patients had reached their rehabilitation aim between T2 and T3. The level of mobility could be significantly improved at the end of rehabilitation (t-test: p < 0.001) in both the THR (n = 127) and TKR patients (n = 110). THR patients required an average of 19.1 ± 4.0 days (range 8-33 days) and the TKR patients on average 19.8 ± 3.4 days (range 12-29 days). Thus, 58 % (n = 74) of THR patients and 51 % (n = 56) of TKR patients had achieved their rehabilitation goal within 21 days. By adapting the rehabilitation period we had achieved the following economic effects: a saving of 28,469 euros could be achieved for THR patients and 15,574 euros for TKR patients.


CONCLUSIONS
Based on the score-driven detection of degree of mobility at the beginning of inpatient rehabilitation, an individual adaptation of the rehabilitation period based on the progress of the patient is possible. Thus, patients who had achieved their rehabilitation goal within the 21 days could be discharged sooner. As a result, in times of limited financial resources, the saved resources can be used for other rehabilitation groups.
Orthopädie und Osteologie, Dr. Becker Rhein-Sieg-Klinik, 51588, Nümbrecht, Deutschland, turg4@web.de.
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D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000175:diagnosis / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000628:therapy*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome