Patient’s who are often diagnosed with a form of osteoarthritis or OA whether it be to their hip or knee, often assume that surgical intervention to replace the involved joint is the solution. Albeit a solution it is not the only option. It is no to surprise if a patient who has OA to a joint does not qualify due to level of severity of their OA, contextual factors in ones personal life (employment status or impending retirement) or insurance related issues. How OA affects normal everyday function is also taken into consideration as to one qualifies for surgical intervention. In countries such as New Zealand (1) a first specialist assessment or FSA is conducted within the first four months of a referral or if surgery is not planned within the four months in order to see if they qualify for surgery. FSA is utilized in order balance the demands and supply, looking to see if every case warrants surgical intervention. One study by Gwynne-Jones et al., took the information provided by the FSA and reviewed the benefits of a Joint Clinic led by Physiotherapist (1). This was done in order to prioritize those most in need of a joint replacement, or to offer non-surgical management for those who would not benefit from a joint replacement surgery at the moment. The results allowed them to prioritize those most in need of surgical intervention and recommend 194 of the original 358 participants to Joint Clinics led by physiotherapist in order manage their pain and functional limitations. This concludes that physical therapy intervention will allow those who have OA to avoid surgical intervention while maintaining regular everyday function.
For patients who require an arthroplasty surgery for a joint such as their hip or knee, also require physical therapy intervention. Physical therapy is often recommended, in order to decrease compensation due to weakened muscles post-op. Lets take someone who recently had a total knee replacement or TKA. A physical therapy led plan of care will include improving ones ROM, scar mobility, gait analysis and a strengthening program that includes their hip abductors, not just solely building their quad strength. In a study by Brian J. Loyd et al., they were able to find the importance of hip abductor strength in relation to knee control during ambulation post total knee arthroplasty or TKA showing, significant loss in hip abductor strength (2). Most importantly these deficits can lead to a decrease in ones dynamic balance, which can increase ones likelihood of falling. It is for these reasons that physical therapy as an alternative treatment can help those who are unable to have the surgery and/or as an intervention post surgery in order to regain functional ability.
Brian J. Loyd, Jason M. Jennings, Dana L. Judd, Raymond H. Kim, Pamela Wolfe, Douglas A. Dennis, Jennifer E. Stevens-Lapsley; Influence of Hip Abductor Strength on Functional Outcomes Before and After Total Knee Arthroplasty: Post Hoc Analysis of a Randomized Controlled Trial, , Volume 97, Issue 9, 1 September 2017, Pages 896–903, https://doi.org/10.1093/ptj/pzx066
Gwynne-Jones DP, Hutton LR, Stout KM, Abbott JH. The Joint Clinic: Managing Excess Demand for Hip and Knee Osteoarthritis Referrals Using a New Physiotherapy-Led Outpatient Service. . 2018;33(4):983-987. doi:10.1016/j.arth.2017.11.034.