Timing of Aquatic Therapy After Joint Replacement Matters

Starting within days of the operation seems beneficial for those with new knees, but not hips

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_119967.html
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By Robert Preidt

Wednesday, December 21, 2011

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WEDNESDAY, Dec. 21 (HealthDay News) -- Starting aquatic therapy within days after total knee replacement appears to improve patient outcomes, but that's not the case for those who've had a total hip replacement, according to a new study.

The number of patients having total knee and hip replacements is increasing, but there is a lack of agreement about the best type of post-surgical treatment, noted the German researchers.

Aquatic therapy has been shown to be beneficial and typically begins two weeks after surgery, when the wound has healed.

This study found that beginning aquatic therapy just six days after total knee replacement may lead to improved results, while delaying the start of aquatic therapy for an additional week may be more appropriate for patients who've had a total hip replacement.

Patients who'd had total knee or total hip replacement were randomly assigned to undergo aquatic therapy either six or 14 days after surgery. Both groups had 30-minute therapy sessions three times a week up to the fifth week after surgery. Their physical function, pain and stiffness were evaluated three, six, 12 and 24 months after surgery.

All of the outcome measures were better in the knee replacement patients who started aquatic therapy six days after their surgery, compared to those who began therapy 14 days after surgery.

But the opposite was true among the hip replacement patients, lead investigator Dr. Thoralf Liebs, of the University of Schleswig-Holstein Medical Center in Kiel, and colleagues reported.

The findings were released online in advance of publication in an upcoming print issue of the Archives of Physical Medicine and Rehabilitation.

Total hip replacement "has a high rate of patient satisfaction, and patients report an improved quality of life after the procedure. Additional interventions, such as early aquatic therapy, may not lead to much improvement," Liebs suggested in a journal news release. But, after total knee replacement, "patients are less satisfied, so the additional intervention has a greater effect."

Liebs hypothesized that the force of the water during aquatic therapy reduces buildup of fluid in the knee joint. Because the knee capsule is closed after knee replacement, reduced fluid buildup leads to less pain.
But in hip replacement surgery, the joint capsule is not closed, so the effect of reduced fluid buildup is less, Liebs explained in the news release.

SOURCE: Archives of Physical Medicine and Rehabilitation, news release, Dec. 21, 2011

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