Total Joint Replacement: Statistics for Post-Surgery and Rehabilitation
Total knee arthroplasty (TKA) is the most commonly performed total joint replacement surgery, with over 600,000 surgeries occurring annually. Total hip arthroplasty (THA) is the second most common.By 2030, the number of knee replacements is projected to rise to over 3 million per year.1
The most common joint replacement patient is under 70 years old and from the baby boomer generation (currently between 57-75 years old).3 Since joint replacement surgery is an elective procedure, many patients will consult with two to three different surgeons before committing to the surgery.
Post-Surgery Patient Satisfaction: Pain and Function
The goals of total knee and hip arthroplasty are to decrease pain and improve functional mobility. Patient satisfaction is the latest tool being used to measure patient outcomes. It is also an important consideration of the new bundled payment models.
However, patient satisfaction is difficult to quantify because it is based on one’s personal approach to surgery and rehabilitation, as well as one’s unique goals. In my personal experience, the baby boomer demographic of patients may overestimate their level of pain tolerance, and underestimate the challenges they may face post-surgery. It is important to continually communicate with your patients that time and patience will be required during the rehabilitation phase, and to help them set realistic goals for themselves during and after that period.
During the rehabilitation phase, you will find yourself face to face with these facts and figures:
- 6 months after post-op, TKA patients walk 16 percent slower and quadricep strength correlates with levels of walking speed compared to their age-matched non-TKA counterparts.2
- 14.1 to 38.3 percent of elderly patients with total knee and hip replacements fall in the first year.3
- Outpatient joint surgery can reduce costs by as much as 30 percent, so there is a national push to decrease the length of stay and find the right low-comorbidity, low-complication patient—a model that is not inclusive of the one-third of joint patients who qualify as medically obese.4
- Virtual telehealth rehab after TKA has similar outcomes and is less expensive in comparison to traditional, supervised post-op rehab in the outpatient setting.5
- Post-operative supervised therapy is not a requirement and often not recommended, and common rehabilitation advice given to patients following THA is to “just walk.”6
We must critically examine and re-think today’s rehabilitation programs for TKA and THA patients. Failure to do so can impede the recovery of the patients’ long-term functional abilities.
Rehabilitation for Total Joint Replacement Patients
In anticipation of the Medicare bundling of the reimbursement payment system, it will be imperative for the rehabilitation clinician to offer “value over volume.” It is my personal goal and passion to investigate and study functional exercises designed for joint replacement patients.
The number one functional goal a total hip and knee patient desires following their surgery is to achieve a more normal gait. A recent publication cited my research and development of an exercise that facilitates a faster return to normal gait pattern for TKA patients.
Similarly, you can learn about gait assistive exercises in my MedBridge course, which focuses on the pre- and post-op gait cycle of THA patients. The exercises presented will be critical tools as you work to rehabilitate today’s joint replacement patient, and separate yourself and your facility from the competition.
- Inacio, M., Paxton, E. W., Graves, S. E., Namba, R. S., & Nemes, S. (2017). Projected increase in total knee arthroplasty in the United States - an alternative projection model. Osteoarthritis and cartilage, 25(11), 1797–1803. https://doi.org/10.1016/j.joca.2017.07.022
- Toda, N., Matsunaga, A., Watanabe, H., Abe, H., Munakata, R., Shigeta, K., & Tsukimura, Y. (2019). Walking speed and postural stability after total knee arthroplasty in elderly patients with osteoarthritis. The Kitasato Medical Journal 49(1).
- Liu, Y., Yang, Y., Liu, H., Wu, W., Wu, X., & Wang, T. (2020). A systematic review and meta-analysis of fall incidence and risk factors in elderly patients after total joint arthroplasty. Medicine, 99(50). https://doi.org/10.1097/md.0000000000023664
- Bodrogi, A., Dervin, G. F., & Beaulé, P. E. (2020). Management of patients undergoing same-day discharge primary total hip and knee arthroplasty. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 192(2), E34–E39. https://doi.org/10.1503/cmaj.190182
- McKeon, J. F., Alvarez, P. M., Vajapey, A. S., Sarac, N., Spitzer, A. I., & Vajapey, S. P. (2021). Expanding Role of Technology in Rehabilitation After Lower-Extremity Joint Replacement: A Systematic Review. JBJS reviews, 9(9), 10.2106/JBJS.RVW.21.00016. https://doi.org/10.2106/JBJS.RVW.21.00016
- Saueressig, T., Owen, P. J., Zebisch, J., Herbst, M., & Belavy, D. L. (2021). Evaluation of Exercise Interventions and Outcomes After Hip Arthroplasty: A Systematic Review and Meta-analysis. JAMA network open, 4(2), e210254. https://doi.org/10.1001/jamanetworkopen.2021.0254