An acute care episode of a patient following bilateral total knee arthroplasty.

More patients with bilateral joint problems are choosing to go through one surgery to replace both joints simultaneously rather than having two separate surgeries. The goals of physical therapy following the surgery are to decrease pain, maximize range of motion (ROM) and strength, improve ambulation, and improve overall function. Few studies have focused on the importance of the acute phase of rehabilitation and most concentrate instead on long-term outcomes and outpatient care. The patient was a 62-year-old male diagnosed with osteoarthritis of both knees. The day before the initial physical therapy evaluation, the patient underwent a bilateral total knee arthroplasty. By the end of his stay, active knee ROM increased to -6 degrees to 88 degrees on the right and -6 degrees to 83 degrees on the left. Passive ROM also increased to -5 degrees to 90 degrees on the right and -5 degrees to 86 degrees on the left. The patient was able to perform supine to sit transfers with supervision and sit to stand transfers with contact guard assistance and his ambulation progressed to wvalking 100 feet on level surfaces with a rolling walker and supervision. The positive gains of this patient suggest the potential value of high motivation combined with early aggressive physical therapy.

Strategies to prevent recurrence of benign paroxysmal positional vertigo.

OBJECTIVE: To determine if a daily routine of Brandt-Daroff exercises increases the time to recurrence and reduces the rate of recurrence of benign paroxysmal positional vertigo (BPPV). DESIGN: Random sample of convenience and retrospective case review. SETTING: Tertiary referral center and outpatient clinic. PATIENTS: One hundred sixteen patients diagnosed with BPPV involving the posterior semicircular canal (BPPV-PC) who were successfully treated with the canalith repositioning procedure. INTERVENTIONS: Patients in the treatment group (n = 43) performed daily Brandt-Daroff exercises, while patients in the no-treatment group (n = 73) performed no exercises. MAIN OUTCOME MEASURES: Follow-up was as long as 2 years. Every 2 months patients were mailed a questionnaire. If BPPV had recurred, patients contacted the principal investigator within 24 hours. Within 1 to 2 weeks, patients were evaluated in the clinic with the Dix-Hallpike maneuver or, if unable to travel to the clinic, interviewed by telephone. RESULTS: Symptoms recurred in 50 (43%) of the 116 subjects, 34 (47%) of 73 in the no-treatment group and 16 (37%) of 43 in the treatment group. There was no significant difference in the frequency of recurrence (Pearson chi(2), P = .33) or time to recurrence (survival analysis, log-rank test, P = .92). A history of recurrent BPPV-PC did not affect frequency of recurrence (Pearson chi(2), P = .33) or time to recurrence (survival analysis, log-rank test, P = .72). CONCLUSION: Our results suggest that a daily routine of Brandt-Daroff exercises does not significantly affect the time to recurrence or the rate of recurrence of BPPV-PC.