Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
In Reply.— We agree with Drs Botney and Stacey that postoperative pain management can affect rehabilitation performance after joint replacement surgery. We previously demonstrated that patients with higher postoperative self-reported pain scores had decreased functional performance and range of motion during the acute care postoperative stay.1 Because of this finding, all patients in our study were offered patient-controlled analgesic immediately after surgery followed by hydrocodone bitartrate and acetaminophen dosed one-half hour before morning and afternoon therapy sessions and then every 4 hours as needed. At our institution, patients have the option to select general or epidural anesthesia. Although we did not study the type of anesthetic management used during surgery, we believe our conclusions remain valid because the type of anesthesia during surgery was randomized across the 2 groups. With regard to DVT prophylaxis, warfarin and sequential compression devices were used from postoperative day 1 through 4 followed by warfarin only until day 7 in the total knee arthroplasty group and until day 21 for the total hip arthroplasty group. Optimal regimens for DVT prophylaxis require continued study, especially with the advent of low-molecular-weight heparins, to determine the most cost-effective regimen with a minimum of adverse effects such as bleeding at the operative site.
Munin MC, Rudy TE, Glynn NW, Crossett LS, Rubash HE. Rehabilitation After Hip and Knee Arthroplasty—Reply. JAMA. 1998;280(16):1402-1403. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-16-jbk1028