Could preoperative rehabilitation modify postoperative outcomes after total hip and knee arthroplasty? Elaboration of French clinical practice guidelines

• Published in: Annales de réadaptation et de médecine physique Vol. 50; no. 3; pp. 189 - 197
• Main Authors: Coudeyre, E., Jardin, C., Givron, P., Ribinik, P., Revel, M., Rannou, F.
• Format: Journal Article
• Language: English
• Published: Paris Elsevier SAS 01.04.2007; Elsevier
• Subjects: Arthroplasty, Replacement, Hip - rehabilitation; Arthroplasty, Replacement, Knee - rehabilitation; Biological and medical sciences; Clinical practice; Diseases of the osteoarticular system. Orthopedic treatment; Education; Guidelines; Hip arthroplasty; Humans; Knee arthroplasty; Medical sciences; Miscellaneous; Occupationnal therapy; Orthopedic surgery; Osteoarthritis; Outcome Assessment (Health Care); Patient Education as Topic; Practice Guidelines as Topic; Preoperative Care; Preoperative rehabilitation; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recommendations; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Recommendations; Occupationnal therapy; Knee arthroplasty; Education; Hip arthroplasty; Osteoarthritis; Preoperative rehabilitation; Clinical practice; Guidelines; Knee; Postoperative; Total knee arthroplasty; Prognosis; Hip; Recommendation; Disability; Hip prosthesis; Orthopedic surgery; French; Reeducation; Treatment; Orthopedics; Preoperative; Rehabilitation
• ISSN: 0168-6054; 1768-3203
• DOI: 10.1016/j.annrmp.2007.02.002

To develop clinical practice guidelines concerning preoperative rehabilitation for hip and knee total arthroplasty. We used the SOFMER (French Physical Medicine and Rehabilitation Society) methodology, combining systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, to develop the guidelines. Main outcomes considered in the recommendations were impairment, disability, medico-economic implications and postoperative complications. A preoperative rehabilitation program, comprising at least physical therapy and education, is recommended before total hip and knee arthroplasty. Occupational therapy could be combined with patient home visits. Isolated physical therapy before total knee arthroplasty (TKA) is not recommended. Multidisciplinary rehabilitation comprising at least occupational therapy and education is desirable for the most fragile patients because of major disability, co-morbidity or social problems. Complementary studies are required to confirm the impact of pre-operative rehabilitation before total hip and knee arthroplasty, to define components of rehabilitation and the patients most likely to benefit. Rehabilitation before total hip and knee arthroplasty contributes to reduced hospital length of and modifying discharge conditions. This rehabilitation necessitates the collaboration of qualified health care professionals in the educational topic and return-home preparation. Preoperative patient assessment is important.