A Review of Lung Transplantation and Its Implications for the Acute Inpatient Rehabilitation Team.

Since the late 1980s, lung transplantation has become an option for some individuals (in 2014, 4000 lung transplantations were performed) with end-stage lung disease aimed to help these individuals restore function and improve survival and quality of life. Individuals living with end-stage lung disease already are deconditioned, with poor endurance and limited exercise capacity. There are additional post-transplantation factors that can contribute to poor endurance and decreased exercise capacity. Although pulmonary rehabilitation in the pretransplantation phase is a crucial component for positive functional outcomes after lung transplantation, the incidence of post-transplantation complications, coupled with the need for immunosuppression, often warrants close monitoring by medical professionals. The acute inpatient rehabilitation unit offers an ideal setting for such patients to receive therapies to improve functional status while allowing for monitoring and medical management with a comprehensive team approach, including both the rehabilitation and the transplantation teams. In this article, we review the medical issues, physiologic changes, common complications after lung transplantation, and potential side effects of immunosuppressant therapy, as well as address rehabilitation specific concerns, outcomes, and goals of the patient undergoing lung transplantation in the acute inpatient rehabilitation unit. LEVEL OF EVIDENCE: V.

Better function for fusions versus above-the-knee amputations for recurrent periprosthetic knee infection.

BACKGROUND: Treatment of chronic periprosthetic joint infections (PJIs) after TKA is limited to fusions, above-the-knee amputations (AKAs), revision TKA, and antibiotic suppression and is often based on the patient's medical condition. However, when both fusion and AKA are options, it is important to compare these two procedures with regard to function. QUESTIONS/PURPOSES: Do patients receiving a knee fusion for PJI after TKA have better function compared to patients receiving an AKA? METHODS: We retrospectively reviewed patients who were eligible for either fusion or AKA after PJI TKA. Thirty-seven patients underwent a fusion for PJIs after TKA between 1999 and 2010. Nine patients died postoperatively and eight patients were lost to followup, leaving 20 patients. Patients completed a specialized questionnaire about their fusion, and functional capability was assessed by the SF-12. We compared fusions to a previously published group of six patients who underwent AKA for recurrent PJI after TKA. RESULTS: For patients with fusion, community ambulators increased from five to 10 and nonambulators decreased from three to one. For patients with AKA, nonambulatory patients increased from zero to two, and community ambulators decreased from four to one. The SF-12 physical component summary measurements were higher for fusions (51) than for AKAs (26). The mental component summary was also higher in fusions (60) than in AKAs (44). Seventy percent of patients indicated they would undergo a fusion again instead of undergoing an amputation if they were presented with both options after undergoing their operation. CONCLUSIONS: Patients receiving knee fusions for treating recurrent PJIs after TKA have better function and ambulatory status compared to patients receiving AKA. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.