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CORR® International-Asia-Pacific: Closing the Loop-Focus Early and Often on Your Patients' Postsurgical Rehabilitation Program.

As an orthopaedic surgeon who performs knee arthroplasties, my goal is to return my patients back to their normal lifestyles. But no matter how well the operation goes, recovery is always critically dependent on a high-quality postsurgical rehabilitation program. And in the Asia-Pacific region, as elsewhere, not all rehabilitation programs are created equal, and many are not evidencebased [5, 16]. Furthermore, in the era of cost containment, the ongoing pandemic, and expanding bundledpayment systems, patients often are discharged shortly after surgery. As such, orthopaedic surgeons have less oversight of the postsurgical rehabilitation process than ever before. Physicians in the Asia-Pacific region face even more challenges because of the variability in the region’s healthcare systems and unique social and cultural barriers [16]. For example, I have worked with many patients who want to continue floor-based lifestyles, which requires a high degree of knee flexion [6]. Therefore, patients and care providers tend to focus on regaining a greater arc of motion rather than restoring healthy muscle function, which is generally a chief indicator of patient satisfaction and functional outcomes after knee arthroplasty [12, 14]. Interestingly, the majority of patients undergoing knee arthroplasty in the Asia-Pacific region are women [7, 9], which is important as we think about designing specific rehabilitation programs tailored to each individual patient’s needs. I have found that rehabilitation programs for women generally emphasize pain relief, ROM, and balance training, whereas men’s programs place a greater emphasis on muscle restoration. Additionally, postsurgical hospital stays tend to be longer in the AsiaPacific region compared to the United States [17], which is likely due, in part, to the fact that there are few well-run rehabilitation programs in the region. But orthopaedic surgeons in the AsiaPacific region cannot ignore the postoperative rehabilitation process just because these programs are not as good as they could be. In fact, a greater emphasis should be placed on our patients’ postoperative rehabilitation for just this reason. Orthopaedic surgeons need to “close the loop” on postoperative patient care, which can be done by focusing on preoperative education, as well as the immediate implementation of postoperative rehabilitation protocols.