Preoperative rehabilitation care in total hip joint replacement by rapid recovery approach in Slovakia

Abstract

Relevance of research: Hip fractures and arthrosis are currently one of the serious illnesses presenting as a serious health problem faced by the aging population. The health problem is not just the wound itself or arthrotic changes accompanied by severe pains and difficulties to get up and walk on the affected lower limb, but also the risk of inadequate healing after surgery. Also, significant disability and reduced ADL performance may continue despite the immense advances in surgical techniques, nursing care and rehabilitation. Nowadays, which is primarily aimed at reducing the cost of health care, it is necessary to ensure that this reduction in costs is not at the expense of the quality of health care and future medical success. In general, physiotherapy for total hip joint replacement is considered to be a routine matter that deals mainly with mobility training, increased muscular strength, and basic day-to-day activities such as bed-to-chair transition, standing and walking. In addition to these attributes, physiotherapists also need the patient's own experiences and psychological responses such as anxiety and fear. Goal and methods of research: The aim of the thesis is to point out the importance of preoperative preparation of the patient for total replacement of the hip joint and its impact on the reduction of recovery after surgery. As a method, a case study of the 33 year patient indicated for total hip replacement was selected. The patient underwent a comprehensive preoperative three-month preoperative treatment (from the moment of indication to surgery to performance itself) and subsequent post-operative rehabilitation treatment of three and a half months. Results: A comprehensive rehabilitation program was developed taking into account the patient's health and Rapid recovery recommendations in preoperative and postoperative care. During the preparatory phase of the operation, the patient was modified by motor stereotype walking, strengthened lower limb muscles, especially musculus quadratus femoris and pelvis stabilizers. Lower limb circumference values increased by 2 cm, hip muscle strength increased from grade 3 to grade 4 of the Janda muscle tests, and shortened muscles iliopsos were released on the affected side. Taking into account the operational complications and subsequent comprehensive care according to Rapid Recovery recommendations, the stay in the hospital was reduced from 12 days to 5 and the patient returned to normal working life from 6 months to 4 months. Conclusion: Rapid recovery program requires the development of a new culture not only in normal orthopedic outpatient clinics but also in hospitals. In the past, and nowadays in some regions of the world, slow recovery with extended acute hospitalization for several weeks has been thought to be the best way for patients to recover and achieve a good result after complete replacement of either the hip or knee joint. The results of total hip joint surgery studies showed a significant reduction in hospital stay without increasing the remission rate. Subsequently, patient satisfaction increased, accompanied by a reduction in health care costs and a faster return to normal daily life.