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After Knee or Hip Replacement, No Place Like Home

Growing numbers of Americans are outliving their joints. More than a million operations are done annually to replace worn-out knees and hips, and that number is expected to skyrocket in the coming decades as the population ages.

Joint replacements typically restore lost mobility, making it possible for people to get health-enhancing exercise and enjoy countless activities that require movement.

As someone who has had both knees replaced, I can attest to the vast improvement in quality of life the surgery bestowed. I can walk and cycle for miles and swim daily without pain, and I can sit through operas, plays and concerts without stiffness.

I can also underscore the general futility of some popular efforts to postpone needed joint replacements, including injections of hyaluronic acid and corticosteroids, braces, shoe inserts and opioid painkillers like OxyContin and fentanyl, none of which are recommended by the American Academy of Orthopaedic Surgeons.

In a study published earlier this year in The Journal of Arthroplasty, medical researchers at the University of Iowa and the University of Texas reported that patients with knee arthritis who use treatments before surgery that the academy does not recommend may be increasing costs by 45 percent. (The academy guidelines strongly recommend only three of the eight preoperative treatments studied — physical therapy, nonsteroidal anti-inflammatory drugs and the painkiller tramadol.)

Ultimately, many, if not most, patients with painful bone-on-bone arthritis opt for a joint replacement. But as the number of these replacements grows (the rate nearly doubled from 2000 to 2010, when an estimated 693,400 total knee replacements were performed), so does the cost to the health care system, prompting some experts to look for ways to minimize the expense of the procedures without compromising the well-being of patients who need them. The latest research — on the value of inpatient rehabilitation for large numbers of patients — offers a promising route to less costly care with no loss of benefit.

It may surprise many to learn that, even if joint replacement patients live alone, the overwhelming majority recover equally well and may experience fewer complications if they go home directly from the hospital and get outpatient rehabilitation instead of spending days or weeks in a costly rehab facility.

By Jane Brody | The New York Times

Illustration Credit: Paul Rogers

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