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To the Editor.— Dr Munin and colleagues¹ demonstrated several benefits of early rehabilitation for patients undergoing hip or knee arthroplasty, including decreased hospital stay and more rapid attainment of short-term functional goals. Unfortunately, the authors failed to assess several important factors that influence the postoperative course of these patients. This study focused on early rehabilitation but neglected the perioperative care provided to their subjects. The anesthetic technique, method of postoperative pain management, and strategy for deep venous thrombosis (DVT) prophylaxis can affect recovery from surgery, thereby altering participation in rehabilitation.

Epidural anesthesia, particularly when combined with epidural postoperative analgesia, decreases blood loss, postoperative pain, and the risk of venous thrombosis in patients undergoing hip or knee arthroplasty.^2-5 Epidural analgesia extending into the postoperative period can improve progress in rehabilitation and shorten hospital stay.^3-4 The benefits of epidural analgesia (decreased pain, improved range of motion, improved ambulation, and less fatigue) . . . [Full Text of this Article]

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RELATED ARTICLE

Early Inpatient Rehabilitation After Elective Hip and Knee Arthroplasty
Michael C. Munin, Thomas E. Rudy, Nancy W. Glynn, Lawrence S. Crossett, and Harry E. Rubash
JAMA. 1998;279(11):847-852.
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