N002 - PRM programme after hip and knee arthroplasty

Accredited in September 2010

Author:

Dr Ieva Michailoviene (Vasiliauskaite)
Rehabilitation, Physical and Sports Medicine Centre
The II Unit of in-patient Rehabilitation
Vilnius University Hospital Santariskiu Klinikos
Tel: +370652658522
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Board cerfication: 2006; No1955

Full description (pdf file)

SUMMARY

This program is designed for patients after hip and knee arthroplasty, mostly due to primary osteoarthrosis. If the arthroplasty is performed for other clinical or traumatic reason, those patients are not excluded. For about 90% of all our patients is performed cemented hip or knee arthroplasty. And hip is replaced using antero-lateral or posterior approach technique.

Due to our country Minister of Health Order, geography and traditions - PRM out-patient and in-patient services are not available in most rural area, rehabilitation is organized as a 20 days in average in-patient PRM Programme. The period can be extended or shorter after assessing the patient's achievement and functional independence.

Payer of the program in National Health Insurance and rehabilitation is free for all insured persons.

Program is carried out in the in-patient Rehabilitation Unit which is the part of Rehabilitation, Physical and Sports Medicine Centre in the University Hospital.

A multiprofesional rehabilitation program is provided by PRM physicians, which coordinates multidisciplinary team work: physiotherapists, occupational therapist, social worker and psychologist, nurses, nurses assistants; in regards to orthotics issues the patients are advised by mainly orthopedists-technicians. Besides it the angiosurgeons consults in case of deep vein thrombosis (DVT) and the orthopaedist- traumatologist as well as doctors of other specialisation is invited in case of indication.

The rehabilitation process is reviewed regularly by PRM specialists, whereas the clinical rounds with the Head of the Centre take place once a week and rehabilitation team conferences with rehabilitation team staff are organized once a week, during which the short term and long term rehabilitation goals are determined. The patients and their relatives with consent of the patient are invited to participate in team meeting conferences.

Treatments: physiotherapy (including massage and physiotherapy in pool); physical modalities (electrical stimulation of the muscles of operated leg; for the other joints if needed and for other comorbid conditions- microwaves therapy, laser, magnetic field therapy, ultrasound therapy, heat and cold therapy); occupational therapy with elements of vocational activities; consultations of psychologist (individual and group psychotherapy, relaxation, art therapy; counselling of family members), social worker; rehabilitation nursing, teaching of patients and relatives; nutritional therapy; orthotics, technical supports and aids; consultation of other specialists if need be (orthopaedist, vascular surgeon, internist, cardiologist or others); speech therapy (if need be due to comorbid condition), medications (like analgetics, anticoagulants and others if need be).

Each PRM specialist writes a medical report at patient's admission and a standardised discharge summary for the patient, his general practitioner and the orthopaedist- traumatologist.