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Poor rehabilitation compliance may be to blame for unexpected outcomes
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As orthopaedic surgeons, we often have patients who claim they had an unexpected or an inferior outcome from the surgery we performed. The outcome may be inferior compared to what they expected, to what we expected or both. This can cause a dilemma and may be lead to litigation. In my practice as an adult hip reconstruction surgeon, the best example of this is a patient who still has some pain and limp months after surgery. Of course, cases like these will present themselves no matter what you do. However, I wonder how we can be sure the patients followed the prescribed rehabilitation program.
We have limited knowledge about the extent to which our patients followed their postoperative rehabilitation program. Moreover, we do not know for sure the impact that fewer rehabilitation sessions or missed sessions had on the patient’s symptoms or level of function months after surgery. Following hip replacement I am sure many patients decrease their daily exercises a few weeks after surgery when they are essentially pain-free. As a result, I presume they resume their usual activities, such as walking, running and heavy lifting, sooner than they should and possibly without having fully regained their needed muscle control to perform those activities.
The power of the thigh muscles can improve significantly in the months following hip and knee replacement, but the problem is that, in general, we do not know how typical it is for the average patient to reach that level of strength. Therefore, when I see patients in my outpatient clinics at 3 months to 5 months postoperatively who say they have unexpected pain in the area of their newly replaced hip, I make sure the implant is well-fixed by taking new radiographs. I also assess them for any signs of a deep infection.
However, I have found that it is just as important to have the patient describe the frequency and type of exercises they performed during their entire rehabilitation period. From this information, it can usually be determined that the patient who presents with pain has stopped or reduced significantly their prescribed rehabilitation program. Are their functional limitations and pain a consequence? We do not know, but we do know that continuous training nearly always contributes to an improved outcome.
We know from the literature that a potential reason for patients’ inferior outcome could be their lack of compliance with the prescribed rehabilitation program. For benefit of our patients, we must make it clear that the postoperative rehabilitation program designed for them must be followed exactly if they are to achieve the expected outcome of the surgical procedure. We should discuss this concept with our patients prior to surgery and make sure they understand it. Perhaps, as an added measure, we should consider having them sign an informed consent in this regard, which ultimately may keep them from suing us later on for a bad surgery or unsuccessful outcome.
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- Per Kjaersgaard-Andersen, MD, is Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Road, Thorofare, NJ 08086, USA; email: orthopaedics@healio.com.
Disclosure: Kjaersgaard-Andersen has no relevant financial disclosures.