To understand further why Pilates is a valuable form of fitness for people with hip and knee syndromes, consider the following background prevalence information. Osteoarthritis of the hip and knee is responsible for almost a million office visits to an orthopaedic surgeon each year and is one of the leading syndromes ultimately leading to joint replacement. Similarly, joint aches (arthralgias) and muscle, tendon, and bursal pains (myalgias, tendinitis, bursitis) frequently require specifically prescribed medical treatment. Often these aches and pains are related to overuse syndromes and can be successfully treated nonoperatively with a short course of oral or topical anti-inflammatory agents and physical therapy. For these patients, it is important to maintain the stretching and strengthening aspects of the physical therapy as a home program after the formal medical treatment terminates. Pilates offers a way to maintain hip and knee function in the form of low-impact strengthening exercises that are readily adaptable to target specific syndromes that may affect the knee or hip and can be incorporated into a home program.
The total number of knee and hip replacements (arthroplasties) being performed in the United States each year is steadily increasing, while the average age of surgical candidates is decreasing (Levine, Jaffe, and Kaplanek 2009). In the United States from 1990 to 2002, the number of primary total hip arthroplasties (THAs) increased 50% per 100,000 persons (193,000 THAs preformed) and the number of total knee arthroplasties (TKAs) tripled (381,000 TKAs performed; Levine et al. 2007; Kurtz et al. 2005; Levine, Jaffe, and Kaplanek 2009). By the year 2030, the number of total hip and total knee replacements is projected to exceed 4 million (Kurtz, Ong, Lau, et al. 2007), and annual hospital costs associated with these procedures are projected to exceed $65 billion by 2015 (Kurtz, Ong, Schmier, et al. 2007).
With the advent of minimally invasive total joint replacement, an interest in rapid rehabilitation protocols and early enrollment in outpatient physical therapy has evolved. A contemporary report has shown early benefits of rapid rehabilitation after minimally invasive total hip arthroplasty (Levine et al. 2007; Berger et al. 2004; Levine, Jaffe, and Kaplanek 2009). In addition, using preoperative and postoperative targeted exercise programs may improve gait adaptations associated with hip and knee osteoarthritis and arthroplasty (Levine, Jaffe, and Kaplanek 2009; Brosseau et al. 2003; Pilot et al. 2006). Joint replacements are on the rise, especially as individuals seek to stay active and maintain good range of motion at their joints without discomfort. Indications for total joint arthroplasty have gradually expanded to encompass younger, more active patients, who in turn are demanding a more rapid and complete return to function as compared with traditional candidates for total joint arthroplasty (Levine et al. 2007; Levine, Jaffe, and Kaplanek 2009). A survey of the members of the Hip Society and the American Association of Hip and Knee Surgeons (AAHKS) showed that Pilates is rated as a sport activity that patients are allowed to participate in after THA (58% allowed without experience and an additional 24% recommended with experience; Klein
et al. 2007).
In a preliminary report from the office notes of Dr. William L. Jaffe, an orthopaedic surgeon and adult reconstructive surgeon at New York University Hospital for Joint Disease, 38 patients noted having used Pilates for their rehabilitation after TKA and THA. There were 22 THAs, with an average age of 46.2 years, and 17 TKAs, with an average age of 55.4 years. At 1 year postoperative, a review of patient charts and follow-up calls revealed that 25 patients were extremely satisfied and 13 patients were satisfied with the use and the subsequent outcome of Pilates in their rehabilitation. There were no patients who ranked their experience or outcome as somewhat satisfied or not satisfied (Levine, Jaffe, and Kaplanek 2009).
A postoperative course of physical therapy for knee and hip arthroplasty varies anywhere from 6 to 12 weeks depending on an individual’s needs. Pilates is a well-suited form of fitness that can be incorporated into the pre- and postoperative exercise regimen and be continued as a home program. The proposed advantages of utilizing Pilates include improving preoperative function, thereby developing a pathway for return to outpatient exercise and providing a whole-body approach to rehabilitation (Levine, Jaffe, and Kaplanek 2009).