人工関節置換術における術前理学療法および自宅評価プログラムの価値

The implementation of prehabilitation prior to total joint arthroplasty (TJA) has been recognized to potentially decrease pain, reduce length of stay (LOS), and increase patient satisfaction. With longer wait times for surgery due to the COVID-19 pandemic contributing to deterioration of function, this study aims to assess the benefits of a physical therapy (PT) and home evaluation program to improve outcomes.

A retrospective chart review of 130 primary THA and 124 primary TKA patients undergoing a new pre-operative PT and home safety evaluation program was performed to assess outcomes. Demographic data were compared to assess baseline characteristics. Pain was evaluated with inpatient/outpatient morphine milligram equivalents (MME) and VAS scores. Mobility was assessed using multiple measures by a physical therapist. Mean postoperative range of motion (ROM), overall complications, and non-home discharge was compared.

Of the 254 TJA patients, 67 (26%) patients underwent the prehabilitation program. Prehabilitation THA patients had statistically significantly higher Boston Activity Measure Post-Acute Care (AMPAC) scores on postoperative day 0, lower subjective VAS pain scores on the day of discharge, and greater 3-month postoperative ROM measurements. Prehabilitation TKA patients had statistically significantly less outpatient opioid MME pain requirements (p < 0.05). There were no significant differences in LOS, discharge destination, use of walking aids, or surgical complication rates.

Prehabilitation programs prior to TJA may facilitate early postoperative mobility and improved pain relief through patient education and conditioning. In older patients with chronic pain, prehabilitation prior to TJA may contribute to lower pain scores and less opioid requirements.