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  • Is physical therapy necessary after total knee replacement?

    Is physical therapy necessary after total knee replacement?

    Staff -  

    In spite of the fact that total knee replacement is recognized as the most effective solution for patients with severe arthritis, according to Andrew Wickline, MD, patient dissatisfaction related to postoperative pain, stiffness and long difficult rehabilitation persist even with modern implant designs. Dr. Wickline joined a panel of joint replacement experts at a recent SwiftPath Symposium, where he questioned the traditional approach to knee replacement and the automatic reliance on arduous and painful physical therapy.

    The SwiftPath Symposium: Proven Methods in Outpatient Joint Replacement featured presentations on modern pain management, peri-articular injections, minimally invasive surgical techniques, and other advances that are making outpatient knee replacement a reality. The next event takes place on May 5, 2017 at Ohio Valley Surgical Hospital in Springfield, Ohio.


    As Dr. Wickline pointed out, “The SwiftPath platform set the stage for me to completely revamp my practice and approach to postoperative physical therapy.


    Craig McAllister, MD, served as moderator for the symposium and pointed out that "knee replacement is a highly successful operation, but postoperative pain and stiffness persist as the single most common cause for patient dissatisfaction. Extensive surgical approaches, bleeding and prolonged hospitalization have likely contributed to the problem — stiffness that naturally lead to months of arduous and painful physical therapy that we come to believe is part of the surgery."


    Traditional surgical approaches generally include everting the patella, tibial dislocation, and extensive soft tissue stripping. Minimally invasive surgical techniques decrease the need for exposure by using downsized instruments, a mobile soft tissue window, and quadriceps preserving techniques. The SwiftPath Program combines these improvements with a comprehensive and systematic approach to patient engagement, modern pain management, early discharge and rapid mobilization.


    Over the last two years, the SwiftPath Program has been used in thousands of joint replacements performed across the country. Using predictive analytics developed by SwiftPath, patients are assigned to a standard hospital stay, 23 hour stay or same-day discharge. Here are four key advantages:


    1. Patients are discharged directly to home with no use of rehabilitation centers, hotels or other types of recovery suites.


    2. Visiting nursing services and home physical therapy are eliminated.


    3. There is minimal blood loss, so postoperative labs are no longer required.


    4. Patients participate in an online, cyber-secure patient-reported outcome system documenting their daily pain experience, weekly rehabilitation, return to activities and overall patient satisfaction.


    The SwiftPath Program has been presented at a Congressional Briefing in Washington, DC, major national orthopedic meetings, and numerous regional meetings.


    Dr. Wickline performs over 600 primary joint replacements per year. In 2016, he began using the SwiftPath Method for all patients. "I saw tremendous growth to 777 primary total joints which I believe is in part due to advertising with SwiftPath and developing a "therapy-free" total joint replacement model for all patients. My length of stay for all comers (70 percent Medicare) went from 1.5 days for hips and 2.23 days to knees to one day LOS for both.


    "In May of 2016, I combined the SwiftPath platform with a therapy free protocol and in eight months sent 239 patients home the same day. This was ALL COMERS. Not just cherry picked patients. My readmission rate pre SwiftPath was 1.01 percent and was 1.01 percent after initiation of the SwiftPath Program.”


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