Arthritis of the Hip and Knee: The Active Person's Guide to Taking Charge.

Arthritis of the Hip and Knee: The Active Person's Guide to Taking Charge

Allen RJ, Brander VA, Stulberg SD. Atlanta, GA 30324, Peachtree Publishers Ltd, 1998, paperback, 229 pp, illus, $14.95.

The authors of this book -- a patient, a physiatrist, and an orthopedic surgeon -- have collaborated to give people with osteoarthritis the information they need to manage their condition, particularly when they are considering replacement of the hip or knee joint. The first 3 chapters (about one fourth of the book) present basic information about disease process and its nonsurgical management clearly, including medications, modalities, exercise, joint protection, and activities of daily living. The remaining chapters cover, in great detail, the process of considering surgery, preparing for surgery, and rehabilitation following surgery.

The first author is an active lawyer who plays competitive tennis and developed osteoarthritis at an early age. His drive to keep physically active through exercise and joint replacements of both hips sets the tone for the whole book. The book emphasizes the need for the patients to "take charge" of their care and to make well-informed decisions with their doctors regarding what treatment is appropriate for them. It supports maximum patient involvement, encouraging patients and families to plan every step of their treatment and to insist on the highest level of care, and it gives them the information they need to accomplish this task. The author-patient makes extensive contributions to all chapters based on his personal experiences, describing his decision-making processes and sharing what he has learned in more than 15 years of dealing with arthritis.

Charts, illustrations, and tables add details that enable the reader to become more participatory. The excellent illustrations include radiographs and drawings that help the reader understand both the disease process and the surgical procedure. The tables and figures provide joint protection and energy conservation principles, surgical and rehabilitation protocols, and many questions to ask when searching for the best surgeon (although this may not be possible in today's managed care environment). An entire chapter discusses exercise, including aerobics, and uses photographs to illustrate stretching and strengthening exercises.

The authors emphasize exercise and its importance in maintaining an active lifestyle while preparing for surgery and for a complete rehabilitation after the operation. They frequently encourage patient involvement with a physical therapist and a physiatrist, especially for those who want to return to an active life. They make it clear that complete rehabilitation from an arthroplasty procedure takes a year and lots of hard work and that the best programs are custom-designed with a therapist and revised as the patient progresses.

However, I have a couple of concerns about this book. Because of the primary author's relatively young age and very active lifestyle (he had a hip revision 8 years following a fracture), the book at times seems to encourage the reader to take unnecessary risks, and the rehabilitation program it describes may appear beyond the level of the majority of patients with osteoarthritis who are older or less active. His experience with custom-made femoral components and the long-term involvement of a physical therapist in his rehabilitation program may not be a reality for many patients today. In addition, his physical conditioning level prior to surgery is not common in the general population with osteoarthritis.

The book mentions different surgical approaches for a total hip arthroplasty, but gives precautions for a posterior arthroplasty procedure only, stating that these precautions (including avoidance of internal rotation) are for all patients undergoing hip procedures. And some of the exercises, especially forced hip flexion and stretch into adduction, will not be appropriate for all patients even after 8 weeks. Dislocation is briefly discussed and dismissed as "rare" without considering that the rarity may be due to the extreme caution or relative inactivity of many of the patients.

The authors frequently state that the reader should check with his or her physician prior to doing any of the program, but some readers may try to use the book on their own. Physical therapists will find this book very useful for giving information to patients with osteoarthritis at almost any stage of their program, especially in preparing them for the surgery and during the postoperative rehabilitation process, but problems may arise for the person who tries to use this book without professional assistance. However, its encouragement to return to a normal, active lifestyle and the description of a patient's experiences should help other patients and therapists find the motivation necessary for more complete rehabilitation following joint replacement surgery.

Carol F Simpson, PT University of California, San Francisco San Francisco, Calif

Ms Simpson currently practices physical therapy at University of California, San Francisco/Mt Zion Home Care and is Assistant Clinical Professor in the Graduate Program in Physical Therapy, where she teaches arthritis and home care.