RESUMEN
This study was aimed at answering the question of whether a four-week inpatient early rehabilitation programme, i.e. within the first two months following total hip replacement surgery, will have a favourable impact as compared to later-onset inpatient rehabilitation measures; a total of 219 patients was studied: 137 were admitted during the first two months post-op (group A), 45 within three to four months post op (group B), and 37 patients were admitted at a later date (group C). Assessments were carried out for pain, walking performance and self-help status (scores) as well as for mobility, gait patterns, walking aids, walking speed, and disablement. In group A patients, significant improvement was achieved for all of these parameters: at the end of the rehabilitation programme (2.4 months post-op) these patients already were more mobile than group B patients at the time of admission (3.3 months post-op). In group B, improvements were found for several parameters. At a later time, the natural healing process had brought about so good a baseline situation in the group C patients that no further improvement was possible. The 162 patients treated successfully, i.e. where score reductions occurred, had been admitted significantly (p = 0.0001) earlier (2.9 months post-op) than the remaining 57 patients (5.7 months post-op). Some 14 months after programme participation, follow-up examinations were possible for 90 patients of group A, and for 27 patients from groups B and C. Further significant improvements had occurred in group A patients only, notably relative to muscle strength and reduction of walking aids. It is concluded from our data that inpatient early rehabilitation will achieve the greatest effect and will substantially reduce the recovery phase with its mobility limitations and daily living handicaps.
Asunto(s)
Artroplastia de Reemplazo de Cadera/rehabilitación , Osteoartritis de la Cadera/cirugía , Admisión del Paciente , Complicaciones Posoperatorias/rehabilitación , Actividades Cotidianas/clasificación , Anciano , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Dimensión del Dolor , Cicatrización de Heridas/fisiologíaRESUMEN
159 patients were examined approximately 15 months after hip arthroplasty. 116 of these patients have had at that time point a postoperative 4 week hospital stay for rehabilitation. A score that considered pain at motion and at rest, maximal walking capacity and activity of daily living was used for evaluation. The preoperative conditions did not differ between patients that had their postoperative hospital stay for rehabilitation (n = 116) and those that did not (n = 43). The results at the time of examination were regarded as excellent (group 1; score 3) in 64 (40.3%) patients, as good (group 2; score 4) in 56 (35.2%) patients and as poor (group 3; score > or = 5) in 39 (24.5%) patients. The amount of patients with a hospital stay for rehabilitation was significantly (p = 0.025) higher in the patient groups with excellent or good results in comparison with the patients with poor postoperative outcome. The most excellent results were obtained in patients who had their rehabilitation within the first two months after surgery (p = 0.008). Apart from the above mentioned score the following-additionally assessed-parameters differed significantly between the 3 groups: hip mobility; pain elicited by pressure on the operated joint; pain in the contralateral hip or knee joints; consumption of analgetics; walking time for 15 meters; degree of handicap as assessed by the patient or the occupational therapist or the physician; coping with household activities (for females only). We conclude that a poor result of hip arthroplasty may be due not only to degenerative joint disease of the lower limbs but also (or in combination) to the lack of a postoperative hospital stay for rehabilitation.
Asunto(s)
Prótesis de Cadera/rehabilitación , Osteoartritis de la Cadera/cirugía , Admisión del Paciente , Complicaciones Posoperatorias/rehabilitación , Actividades Cotidianas/clasificación , Anciano , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Complicaciones Posoperatorias/etiología , Centros de Rehabilitación , Resultado del TratamientoAsunto(s)
Prótesis de Cadera/rehabilitación , Actividades Cotidianas , Factores de Edad , Anciano , Femenino , Articulación de la Cadera/fisiología , Servicios de Atención de Salud a Domicilio , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , CaminataRESUMEN
Fifty patients who underwent total hip replacement were examined within 3 months by two independent investigators with respect to functional impairment of the sacroiliac joint. Several well-defined clinical tests were used, e.g. spine test, standing flexion test, Menell's sign, tenderness of the sacroiliac joint. The results of both investigators were comparable, with corresponding results in 94 per cent. Nearly 30 per cent of the patients showed functional impairment of one sacroiliac joint. This finding may partly cause the gluteal or low back pains which are reported by patients after hip replacement.