Can Early Rehabilitation after Total Hip Arthroplasty Reduce Its Major Complications and Medical Expenses? Report from a Nationally Representative Cohort.

Daniel Chiung-Jui Su,Hing-Man Wu,Kuo-Shu Yuan,Willy Chou,Shih-Feng Weng,Rong-Bin Hong,Ming-Ping Wu

doi:10.1155/2015/641958

Abstract

Objective. To investigate whether early rehabilitation reduces the occurrence of posttotal hip arthroplasty (THA) complications, adverse events, and medical expenses within one postoperative year. Method. We retrospectively retrieve data from Taiwan's National Health Insurance Research Database. Patients who had undergone THA during the period from 1998 to 2010 were recruited, matched for propensity scores, and divided into 2 groups: early rehabilitation (Early Rehab) and delayed rehabilitation (Delayed Rehab). Results. Eight hundred twenty of 999 THA patients given early rehabilitation treatments were matched to 205 of 233 THA patients given delayed rehabilitation treatments. The Delayed Rehab group had significantly (all p < 0.001) higher medical and rehabilitation expenses and more outpatient department (OPD) visits than the Early Rehab group. In addition, the Delayed Rehab group was associated with more prosthetic infection (odds ratio (OR): 3.152; 95% confidence interval (CI): 1.211–8.203; p < 0.05) than the Early Rehab group. Conclusions. Early rehabilitation can significantly reduce the incidence of prosthetic infection, total rehabilitation expense, total medical expenses, and number of OPD visits within the first year after THA.

Highlights

A disabled hip joint is a major inconvenience because it reduces one’s functional ability and secondarily increases comorbidities caused by immobility
Linear regression analyses showed that delayed rehabilitation group had higher total medical expenses (p < 0.001), higher total rehabilitation expenses (p < 0.001), and more postoperative outpatient department (OPD) visits (p < 0.001) than the early rehabilitation groups (Table 2)
Logistic regression analyses showed that the delayed rehabilitation group was associated with a higher rate of prosthetic infection (odds ratio (OR): 3.152; 95% confidence interval (CI): 1.211–8.203; p < 0.05) when compared with early rehabilitation group

Summary

Introduction

A disabled hip joint is a major inconvenience because it reduces one’s functional ability and secondarily increases comorbidities caused by immobility. A total hip arthroplasty (THA) is mandated. One review [1] showed that primary osteoarthritis (OA) is the main indication for more than 65% of all primary THA performed in the USA, Scandinavia, Scotland, and Australia. The success of THA is its predictable pain relief, improvements in quality of life, and restoration of normal function [3]. Brander et al [4] point out that, to achieve maximal functional performance, rehabilitation should focus on reducing pain, increasing range of motion, and strengthening the hip muscles, for example, the gluteals and quadriceps and the hamstring muscles

Methods

Results

Conclusion