Rehabilitation after total hip and knee arthroplasty: a new regimen using Pilates training
Rehabilitation after total hip and knee arthroplasty is a rapidly expanding discipline. With the introduction of minimally invasive techniques and the pressure of insurance regulations, postoperative rehabilitation has been placed on an accelerated track. As surgeons turn to more aggressive postoperative protocols and early entry into outpatient therapies, we introduce a pre- and postoperative program involving the Pilates method. Renewed patient interest in the use of Pilates for postoperative rehabilitation has led to the development of safe and modified exercises for patients undergoing total hip or knee arthroplasty. While this technique appears safe and effective anecdotally, further controlled trials are necessary to prove its validity.
The prevalence of total hip and knee arthroplasty is rapidly increasing in the U.S. In a recent report, the number of primary total hip arthroplasties increased from 119,000 to 193,000 between 1990 and 2002. (1) Concomitantly, the number of total knee arthroplasties tripled from 129,000 to 381,000 between 1990 and 2002. (1) During this time, the health care environment and insurance regulations have changed dramatically, driving a push for shorter in-patient hospital stays for total joint arthroplasty patients. Concomitantly, the benefits of early rehabilitation and patient mobilization were also being realized. Ganz and colleagues reported on the nature of discharge and rehabilitation milestones in 11,000 total hip arthroplasties from 1990 to 2000. (2) They found a decrease in the average length of hospital stay from 9.7 days to 5.3 days over this decade. More recently, there has been an effort to limit inpatient stays to 72 hours. In addition, some surgeons are now performing total hip and knee replacements on an outpatient (or 23-hour stay) schedule. (3-5)
With the advent of minimally invasive total joint arthroplasty, an interest in rapid rehabilitation protocols and early enrollment in outpatient physical therapy has evolved. A contemporary report has shown early benefits of rapid rehabilitation after minimally invasive total hip arthroplasty. (4) The goals of early discharge, rapid mobilization, and expedited entry into outpatient physical therapy were realized by the majority of patients in the aforementioned study. While there have been no reports in the current literature, there is no reason that such an accelerated regimen could not be applied to all total joint replacements, including those with traditional incisions. It is also reasonable to infer that these patients also would respond well to this more aggressive approach to postoperative rehabilitation.
Indications for total joint arthroplasty have gradually expanded to encompass younger, more active patients who, themselves, are demanding a more rapid return to function. With this in mind, we have explored the concept of using the Pilates method for preoperative and postoperative rehabilitation in total joint arthroplasty patients. The advantages of using this method include maximizing preoperative function, developing a pathway for a swift return to outpatient exercise, and promoting a whole body approach to rehabilitation. It is the objective of this communication to introduce simple, modified preoperative and postoperative rehabilitative protocols for total hip and knee arthroplasty patients, applying the Pilates method.
History of Pilates