Hip and knee replacements have been one of the success stories of recent times, enabling people to regain mobility and live comparatively pain free. So much so that, according to the National Joint Registry, in the UK some 160,000 procedures are carried out every year.
So is it a case of hip, hip, hooray for the NHS? Well, according to a report released by the Chartered Society of Physiotherapy it is more a case of ‘could do better’. Their findings come from a major audit into hip replacement procedures which revealed that after-care is sadly more of a postcode lottery than it should be. With only 20% of health authorities maintaining continuity of care following a hip operation some patients are just not receiving the physiotherapy which they need in order to help them to make a full recovery.
This can have serious consequences. Hip fracture is the most common cause of injury related deaths in adults, costing the NHS and social care £1b per year. Any delay in starting a personal recovery and physiotherapy programme can not only hamper the chances of full recovery, it can also lead to further complications due to the lack of mobility. These can include chest infections and blood clots, both of which can prove fatal. Moreover, if muscles and ligaments are not re-trained as soon as possible following an operation the damage may be irreversible, leaving the patient wheelchair bound and relying on care services for ongoing support.
In response to the study the Chartered Society of Physiotherapy has launched a best practice care standard for hip operations. This states that all patients should receive an assessment by a physiotherapist within a day of their operation. This should be followed by at least two hours of physiotherapy in the week following hip replacement surgery with a further two hours per week until they are fully recovered.
Whilst two hours per week may not seem very much, it represents a considerable improvement on the less than an hour a week which the survey revealed some patients were receiving. And even that was better than the 80 day wait for rehabilitation which faced some patients after their operation. And we shouldn’t forget that a regular programme of physiotherapy will also help patients to stay on track with their own recovery regime; with physiotherapists being able to check that exercises are carried out as well as suggesting alternatives should the current rehabilitation regime not be as effective as it could be.
Undoubtedly the requirement for two hours treatment per patient per week will place added strain on the physiotherapy profession. However, this will be partially offset by a reduction in ongoing requirements to treat patients who have developed life-long care needs as a result of not having appropriate treatment immediately following their operations.
Commenting on the new care standard Chartered Society of Physiotherapy Chair, Alex Mackenzie, said “Our ageing population means there are more people than ever before at risk of hip fracture and it is vital they can access high quality, timely and intensive rehabilitation.”