Joined: September 22, 2004
I would like to ask about using US treatment after total knee replacemant surgery. An orthopaedic surgeon issued an order for US Tx for a home health pt. Does somebody have an experience in using such modality and any suggestions or possible contraindications? I would appreciate any response.
Joined: September 15, 2004
gubernik, Is it a cemented to ingrowth prosthesis. I was taught that the frequency of US can weaken the matrix of the cement. I have used it after TKA but only on rare ocassions and then only with ingrowth hardware. Hope this helps.
Ask the Orthopedic Surgeon to show you a published research article documenting the benefits of US post total knee, no, better not do that, instead maybe contact him and discuss alternatives for improving active and passive soft tissue mobility and reducing inflamation and pain---Active Exercise. Rick
Joined: January 31, 2005
Please also consider Mobilization for this purpose. If the surgeon's picky about it, then hey it's up to you to decide pulsed vs continuous and intensity/freq.
I do think that the stark differences in density between the prosthesis and the bone would be the problem, and cause the increased temp/burns, hence the cement concerns that FallsPT mentions. If he/she is insistent, then by all means bring up your concerns.
I think like the others, that you will be better off, efficacy-wise, with other options.
Joined: October 9, 2001
From: Pittsburgh, PA USA
I too was always taught about the loosening of the cememt, but where is the proof of that? If the daily walking and transferring of a 300lb woman doesn't loosen the cement, will 5 minutes of US?
Of course there is risk versus reward. Since we are not really and truly sure, why take the risk over the miniscule effects that the US would provide to this patient.
If you really think it will tick off the MD and patient that you don't do the procedure, just don't turn it on, do the pretend US, and don't bill for it. Use that 5 minutes to talk with the patient and educate them/earn their trust and respect.
John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
John M. Duffy, PT Board Certified Orthopaedic Clinical Specialist www.PTupdate.com
Joined: March 12, 2004
I was thinking along the same lines Duff. Hell, to humor the patient, act like you're setting some arbitrary numbers on the US unit. Let him/her think the numbers mean somthing neat and cool and do like Duff says...provide him/her education about the benefits of an active program.
That's a possibility, but unless you already know the doctor well and are certain of your relationship with him it would be a big mistake. Probably the quickest way to piss off a doctor and lose a referral source is to tell him he is wrong.
Depending on what kind of marketing, physician interface you have you might be able to present the same message gently over time.
Joined: September 15, 2004
The thought on US over the cemented prosthesis was that it could potentially weaken the bonding matrix of the cement not that it would directly loosen or weaken the prosthesis. This was also years ago when the early cements were being used (polymethylmethacrylate i beleive). The newer formulated cements may not be affected. Also don't we have to do 8 minute minimum treatments to meet the billing requirements. There is also not direct proof that US over the lower back of pregenant women affects the fetus but it is still a contraindication.
I'm with Rick - even the placebo US without billing is too close to BS - if we can not even tell a patient about the validity of a treatment (in this case: Lack of), then why are we in this profession? Let's be a bit more affirmative and just contact the surgeon and ask why he thinks US is required: s/he may have info that needs updating in our knowledge base, or in his/hers. I think the contraindications are mostly at the extreme side of careful, but since there is no evidence that I know of that US is beneficial for TKR - we should not even worry about applying US.
I refuse to do US and have gotten in trouble many times from my superiors but how can I justify performing a treatment that is not shown to have effectiveness as well as their being other treatments that are far more effective than US. The last time I used US (for a patient of another PT), I forgot to start the machine yet the patient said they felt it helped them. Interesting!!!! One of out referral sources constantly checks US on his referrals but usually checks eval and treat, which I do and I don't do US. If he doesn't check that and call with the reason I don't feel I should do it. I wish physicians would get more educated on this topic and stop writing it on our referrals.
Joined: January 31, 2005
Dan, I wish we would just do what we know the patient needs, and let the physician decide whether to be pissed off or not. This seems an ethical issue as much as anything else.
How long must we remain in the "Me Doctor, You Therapist" mode? I remember those referral pads...they were funny! We had a "wall of shame" in the break room where we posted some of the more ridiculous ones from some bone head that a school gave an MD degree to. Patient and provider info blocked out, of course. I think our loyalty should be to the patient, not to the referral source, don't you? J