What should I consider before undergoing joint replacement surgery?

The number of joint replacement surgeries in the United States has grown exponentially in the last several years. And while it is a common surgery there are some things to consider before undergoing the procedure. 

Conservative treatments and activity modifications should always be the first line of treatment.   These include things such as weight loss, exercise, injections and physical therapy.  Losing excess weight will help to reduce the amount of force applied to your joints.  According to the John Hopkins Arthritis Center being just 10 lbs. overweight can add up to 60 lbs. of force to your knees.  This excessive force causes more wear and tear to the joint and further destruction of cartilage.  Exercise can help to improve muscular strength providing support to the joint and can help to reduce pain.  Regular moderate intensity physical activity can also help with weight loss goals.  Surgeons can also provide steroid injections into the joint which can provide temporary pain relief and reduce the inflammation.  They can also try injections of a gel-like substance that is based on hyaluronic acid which is a naturally occurring substance in our joint fluid.  It helps to lubricate the joint and, in some cases, can provide some pain relief for 6-12 months.   Participating in physical therapy can improve the strength and flexibility of the appropriate muscles to help support the joint and reduce pain and pressure.  By increasing your strength, endurance and function physical therapy could help to postpone or maybe even avoid surgery. 

But if conservative methods have failed and joint replacement surgery is the appropriate treatment then there are other things to consider.  First is to select the best surgeon.  You want to look for a surgeon who specializes in joint replacements and performs a high volume of surgeries annually.   Check out outcome data if possible, to see the surgeon’s success rate as well as their complication rates.  Next consider undergoing some “prehab” at physical therapy.  A study in the Journal of Bone and Joint Surgery found that 1-2 sessions of pre-operative physical therapy reduced the post-operative care use by 29%.  The physical therapist can provide you with education regarding post-operative expectations in terms of swelling, and mobility challenges.  They can also evaluate your current strength and mobility deficits and provide exercises for you to start performing to help increase muscle activation.  During the prehab visit the therapist can also help you to plan for your post-operative recovery by instructing you on the proper way to use an assistive device such as a walker or cane for ambulation and teaching you how to climb stairs safely after surgery.  Other things to consider before undergoing joint replacement include having a support system in place post-surgery.  You may need to make some modifications to your home such as removing throw rugs and other possible obstacles, obtaining adaptive equipment such as a shower chair or raised toilet seat to make daily activities easier while your mobility is reduced.  Driving is also typically restricted for at least 4-6 weeks post-surgery.  Rehabilitation after joint replacement starts immediately to help initiate muscle contraction and increase early mobility to decrease swelling, improve range of motion and decrease pain.  The rehabilitation process takes commitment in order to achieve the best results. Generally, after 3 months post-surgery individuals have returned to their normal daily activities, but they may still have some mild swelling and weakness for up to a year post surgery. 

If you have questions or want to pursue physical therapy to help reduce your joint pain and improve your function, contact our office to schedule an evaluation.  For a consumer-friendly guide to joint replacement go to www.moveforwardpt.com.

 

References:

Johns Hopkins Arthritis Center: https://www.hopkinsarthritis.org

Journal of Bone and Joint Surgery: https://www.jbjs.org/

I owe what? I'm so confused....

What do I owe?  It’s so confusing, I don’t understand.

If you get a bit tripped up understanding the insurance lingo and struggle to understand what your financial responsibility is and why, you are not alone!  Usually the portion of the payment for which the patient is responsible is either the deductible, coinsurance or copay.

A deductible is an amount set in the insurance contract that is paid in full prior to the insurance company paying some or all of the payment to your healthcare provider.  The amount of deductible varies widely between policies.  On the low side a deductible may be $150.  High deductible policies could have upwards of $6000 per policy year. 

A typical policy with a deductible will also require coinsurance once the deductible has been met.  The coinsurance amount is a percentage of the allowable payment for the visit procedure.   To simplify the example, let’s say that the reimbursement to your physical therapist for your treatment is $80 each visit.  (This is purely an example, as most visits are based on the reimbursement of therapy procedures during each visit and the amount may vary depending on treatment.  Some insurance companies may have a flat reimbursement rate contract with a provider.)  Following the example, if you have a $1500 deductible, you will owe the full amount of the therapy visit, in this case $80, until the deductible has been met by any of your medical visits which apply to your deductible.   So, any doctor’s visits, specialist visits, diagnostic testing, urgent care visits, etc. will all go toward your deductible per your insurance policy.    If you owe a coinsurance after reaching your deductible, then you would owe that percentage of the visit versus the whole reimbursement amount.  So, to follow our example, if you have a 20% coinsurance, once your $1500 deductible has been met, you owe 20% of the reimbursement for your therapy visit.   In our example that would be 20% of $80 or $16 per visit. 

The last form of patient responsibility, the copay, tends to be more straight forward than coinsurance.   Copays are a flat fee owed at each visit.  The copay owed may vary as to whether you are seeing your primary care physician or a specialist.  Copays usually are not tied into a deductible.  

It’s always advisable to verify your benefits with your insurance company so you don’t end up with any surprise expenses.    Don’t hesitate to ask for clarification from your insurance company with your questions and concerns.  

 

Kristen Pagano, Administrator

How P.T. can help pain and fight the opioid epidemic

The United States has a big problem. We have become a place where opioid medication is handed out almost like candy to deal with pain of all types. We consume 99% of the world’s supply of hydrocodone. So, we should all be feeling great, right? Sadly, no. While the number of people using pain medication has increased, reported pain has not changed. Also, there are serious side effects that may occur with using these types of medications.  One of the most serious side effects is that these medications are habit forming. In 2014, two million Americans were addicted to opioid pain medications. This can often lead to abuse of other illegal drugs.

  

In 2016, The United States Surgeon General sent a letter to doctors addressing the issue. As part of the plan to fight this epidemic, several suggestions were put forth. One of those things was the use of exercise and physical therapy as a type of treatment that should be considered before prescribing addictive pain medication.

So how can physical therapy help?  Physical Therapists are uniquely trained to assess and manage musculoskeletal pain and dysfunction. Physical therapists can help guide patients through exercise programs tailored specifically for their problem as well as provide hands on manual therapy techniques designed to improve mobility and reduce pain. Physical therapists can also provide education on ways to lessen your pain and strategies to get back to normal life. In a study published in the journal Health Services Research, findings indicate that patients who saw a physical therapist before trying other treatments had an 89% lower probability of needing an opioid prescription. 

Physical therapy is a frequently under-utilized option that should be considered as a first line treatment for pain. It offers an opioid free, long term solution for treating the primary cause of pain. If you, or someone you know, is suffering with pain due to a musculoskeletal issue, consider asking your doctor about physical therapy or call us directly at 717-790-9994 to set up an appointment to be evaluated.

 

Stephany Primrose, P.T.

 

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Disclaimer:  The information in this medical library is intended for informational and educational purposes only and in no way should be taken to be the provision or practice of physical therapy, medical, or professional healthcare advice or services. The information should not be considered complete or exhaustive and should not be used for diagnostic or treatment purposes without first consulting with your physical therapist, physician or other healthcare provider. The owners of this website accept no responsibility for the misuse of information contained within this website.

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