What is Joint Replacement Surgery?
Physical therapy has proven to be important in getting back to motion after a procedure such as a joint replacement surgery. Osteoarthritis, the wearing down of cartilage cushions in joints over time, is the primary reason for hip and knee replacements. This causes painful bone-on-bone grinding, stiffness, and loss of range of motion. Non-surgical approaches like medications, injections, walking aids, weight loss, and physical therapy can help initially. Ultimately though, joint replacement becomes the most effective option for restoring function and eliminating pain. During surgery, the damaged joint surfaces are removed and replaced with artificial components shaped to restore the joint’s natural form. These components are fixed into the bone, enabling smooth new gliding surfaces so patients can bend and bear weight without arthritic pain.
The Benefits of Physical Therapy
Physical therapy utilizes customized exercises, hands-on treatments, and patient education to improve mobility without medication or surgery. Physical therapists play key roles for joint replacement patients by helping:
- Strengthen muscles to properly support implants
- Regain range of motion and prevent post-surgical stiffness
- Learn proper movement patterns and walking mechanics for optimal healing
- Educate on precautions and safe motions after surgery
- Use modalities like ice, heat, and e-stim to control swelling and pain
- Determine appropriate timelines to resume activities like work, driving, sports
Prehab – Getting Primed Before Surgery
Many patients participate in physical therapy in the weeks leading up to their joint replacement. Prehab therapy assists by:
- Improving stamina and conditioning to handle surgical stress
- Building hip, knee and core muscle strength through targeted exercises
- Practicing post-surgery exercises like walking, range of motion, stairs
- Providing education on hospital and recovery expectations
On average, patients attending some degree of prehab therapy demonstrate faster mobility gains after surgery and fewer complications like infections or blood clots. Hospital stays may also be shorter.
Hitting the Ground Moving – Immediate Post-Surgery Therapy
Not long ago, joint replacement patients remained on rigid bed rest for many days after their procedure, leading to muscle weakness and surgical complications. Growing evidence now supports more accelerated rehab pathways. Beginning physical therapy as soon as safely possible benefits patients by:
- Reducing risks linked to prolonged inactivity
- Controlling pain better while avoiding over-sedation
- Restoring range of motion faster to prevent future stiffness
- Building confidence to functionally progress milestones
- Achieving discharge criteria sooner due to early mobility
While first sessions start simple, the goal is to have patients walking with assistance as rapidly as appropriate based on their condition. Clear communication between surgical and therapy teams ensures the proper progression speed.
Continuing Rehab Inpatient and at Home
The average hospitalization is 1-3 days, including several physical therapy encounters focused on transfers, walking, light leg exercises, and stairs. Criteria for discharge home typically involves getting in/out of bed, walking at least 150 feet with support, and navigating stairs.
Formal physical therapy continues 1-2 times per week at home or in outpatient clinics. Goals now involve maximizing strength and function for daily living activities and return to work or recreational hobbies over 6-12 weeks. Gradually assistive devices are diminished and more impact is integrated. While most intensive therapy occurs in the first three months, it may continue periodically for 6-9 months.
The Role of Underlying Health Conditions
Multiple chronic conditions like diabetes, heart disease, obesity and lung disease are common in joint replacement patients. Research shows these comorbidities can negatively impact outcomes and make rehab more challenging. One study found that in hip replacement patients, greater comorbidities diminished the correlation between amount of physical therapy and postsurgical functional gains. But this relationship still existed in knee replacement patients regardless of multiple conditions. So while health problems affect the rehab path, monitoring functional progress remains vital for guiding appropriate physical therapy timelines.
Overcoming Barriers to Immediate Post-Surgical Therapy
Given the benefits of early physical therapy after joint replacement, what barriers can prevent this from happening? Operational factors like operating room timing, longer surgeries, anesthesia type, nursing bandwidth, and therapist availability were main contributors according to one hospital’s analysis. Patients having later, more complex surgeries had lower odds of engaging in same-day therapy compared to earlier, shorter cases. This highlights the need for coordinated surgical planning to best accommodate immediate rehab when suitable. Additionally, general anesthesia was linked with therapy delays over regional anesthesia which better preserves muscle control and pain relief around surgical joints.
The Bottom Line
While more research is still needed to clarify optimal physical therapy protocols, current evidence overwhelmingly demonstrates favorable outcomes when therapy occurs both before and soon after joint replacement procedures. Communicating with your surgical team is essential to ensure physical therapy integrates appropriately into your treatment timeline.
If you are considering joint replacement surgery and want expert guidance on your condition, surgical options, and postoperative rehabilitation, reach out to orthopedic specialist Dr. Herrick J. Siegel at Siegel Orthopaedics. Providing personalized care for patients in Birmingham, Alabama and surrounding communities, Dr. Siegel’s clinical interests include complex joint reconstruction, limb salvage procedures, and musculoskeletal oncology. Call today to schedule your consultation.