Why Inpatient Rehabilitation after a total hip or knee replacement verses just going home from the acute care hospital?
This seems to be a question that comes up within the rehabilitation community. From working first hand on the inpatient orthopedic unit at Helen Hayes Hospital, a number of reasons come to mind.
First, achieve faster, better pain control. Many times we witness that patients have adverse reactions to certain pain medications. Here at Helen Hayes Hospital, we will work with the individual patient to find the right pain medication for them: one that gives pain relief, without making them feel “sick.” We will also find other non-narcotic medications to help improve pain control. If a patient goes directly home from the hospital, the pain medication prescription they are given may not be adequate, or worse, may make them sick. Trying to get a different medication as an outpatient presents another whole set of obstacles for the patient and their families. Many times doctor’s offices are hesitant to call in narcotics, and pharmacies require written prescriptions to fill orders.
Second, post operative medical complications. A patient has taken the time to plan out their elective surgery for a hip or knee replacement. They have probably researched, or asked around, about their orthopedic surgeon. They have gone to a medical doctor, and maybe even a cardiologist or pulmonologist, to gain clearance for their planned surgery.
However, even the best laid plans, can sometimes present with “speed-bumps!!” These are complications that can happen following anesthesia, pain medications, or other causes, and may not present until days after the surgery. For example, an arrhythmia of the heart, a blockage of the intestine, severe blood loss anemia due to surgery, hypoxia (low oxygen levels), bleeding into the joint or intestine, a blood clot in the calf, or even more serious, a blood clot to the lung! If the patient goes home, they are left to go back to a hospital emergency room to address these potential complications. However, if they come to inpatient rehabilitation, these complications can be quickly addressed by our medical and nursing team. Concise and appropriate medical intervention can prevent emergency room visits, provide the patient with a quicker resolution, and allow initiation of rehabilitation services sooner.
Third, more hours of therapy within the week following surgery to help mobilize the patient. The patient will participate in multiple therapy sessions throughout the day which will help educate, and re-inforce education already received, in procedures of how to “exercise” their new joint. They will experience a better self-confidence on how to continue to proceed with their rehabilitation plan after leaving us.
Robert D. Holland, MD
Kathleen Nicpon, NP
Joint Replacement/Orthopedic Rehabilitation Service