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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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There are two surgeons who have been recommended to me for my total hip replacement. I've been told that one does things the standard way after surgery. The other surgeon uses an accelerated method of rehab and recovery. What's the difference?

Surgeons, health care administrators, and physical therapists are all working together to find ways to reduce hospitalization and complications after orthopedic surgery. Total hip and total knee replacements are so common now that they have become the focus of attention in this area. A faster approach to rehab and recovery called the accelerated protocol has been developed for total joint replacements. The idea is to shorten the time to recovery. The goal is to reduce costs without adverse effects on the patient's recovery. There are many ways in which the accelerated treatment plan is different from the standard postoperative care. Right from the start, the accelerated group is treated together. Together, as a group, they receive information and patient education about the procedure before hospitalization. The standard protocol calls for individual patient information one-on-one the day of the surgery. Patients in the accelerated group are all placed together in one separate part of the hospital surgical ward. In the standard approach, joint replacement patients are put in rooms randomly on the Med/Surg floor. One nurse is in charge of the entire rehab team of nurses, physical therapists, and occupational therapists. In the standard care approach, each health care professional works independently and there are various nurses in charge. Accelerated patients begin rehab with the physical and occupational therapists on the day of surgery. Daily goals are preset. Therapy is intense and designed to get them up and moving as quickly as possible. Movement (mobility) and exercise are performed eight hours daily. The standard group doesn't start until the first day after surgery and they go gradually at their own pace. Mobilization is limited to four hours each day. In addition, a special focus was placed on fluid intake for the accelerated group, including two protein drinks each day. Studies have been done comparing the results for the two groups. Measurements taken and compared have been based on length of hospital stay, health-related quality of life, and any adverse effects. In a recent study from Denmark, these measures were obtained for the first three months after surgery. Costs associated with each approach were added up and compared for a year after the procedure. Evidence from this particular study points to the use of an accelerated pathway after surgery for both hip and knee replacements. The benefit to society in terms of cost savings and to the individual patients is evident.


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