New study seeks to prevent breathing problems after joint surgery

By Jill Pease

A University of Florida College of Public Health and Health Professions researcher is partnering with colleagues at UF Health Jacksonville to explore whether a brief breathing exercise program can help patients undergoing a total joint replacement avoid breathing problems following surgery.

two therapists looking at laptop in hospital room
Travis Wylie, P.T., D.P.T., a research therapist, and Ashleigh Trapuzzano, P.T., D.P.T., a study coordinator, prepare to test breathing function in a patient who has completed a total joint surgery.

“Even short periods of general anesthesia and mechanical ventilation can lead to temporary post-operative declines in lung and respiratory muscle function,” said lead investigator Barbara Smith, Ph.D., P.T., an assistant professor in the PHHP department of physical therapy. “While most people do not have a problem with these declines, people with existing medical issues can experience problems with shortness of breath and recovery of function early after surgery.”

Total joint replacements are among the most common surgeries performed in the United States. More than 1.2 million Americans receive a total knee or hip replacement a year.

Older adults, people who smoke, individuals with socioeconomic disadvantages and those with significant pre-existing lung disease or multiple medical conditions may face a greater risk for declines in lung and breathing function following joint replacement surgery. While pre-surgical standards of care include approaches to improve patient outcomes, such as referrals to smoking cessation classes and exercises to strengthen the leg that will receive the new joint, there are no current standards for strengthening breathing for patients who are at risk of complications.

Smith will collaborate with colleagues in rehabilitation services, orthopedic surgery and anesthesiology at UF Health Jacksonville’s downtown campus to conduct the study, which is funded by the National Institute on Aging of the National Institutes of Health. The urban setting offers several advantages for this research, Smith said, including the opportunity to include more patients who have factors that put them at risk for postsurgical breathing problems and traditionally have not been well-represented in health research.

Dr. Barbara Smith

For the study, researchers will test whether a breathing exercise program known as inspiratory strength training, or IST, can improve patients’ respiratory strength and prevent breathing problems following their joint replacement surgery. IST has been shown to reduce breathing problems in patients who have undergone heart surgery, but it has not yet been studied with patients receiving shorter surgeries, such as a joint replacement.

Participants with risk factors for postoperative breathing problems will be randomized to receive standard of care or to one of two groups that will receive training prior to their joint replacement surgery. One training group will receive IST five days per week with remote supervision from a training coach. Because access to care may be an issue for some patients, investigators will examine the effectiveness of a single IST session conducted immediately prior to surgery in a second training group. Researchers will test participants’ respiratory muscle function at baseline, day of surgery and at 24 hours after surgery.

“Post-operative pulmonary complications delay patient’s discharge after surgery, incur significant health care expenses, and place patients at risk for longer or incomplete recovery from joint surgery,” said Smith, a member of UF’s Breathing Research and Therapeutics Center, or BREATHE. “Strategies like these have the potential to preserve or improve respiratory function, leading to faster recovery from surgery and better patient outcomes.”