Hip and knee replacement surgeries are currently on the rise more than ever. Everyone reading this likely knows a friend or family member that has had a joint replacement. Studies show that 50%+ of all people will have pain and motion loss due to knee osteoarthritis at some point in their life. Arthritis is the term used to describe loss of cartilage or the padding in a joint.
Will joint replacement help my arthritis?
Joint replacement has now become the gold standard treatment for severe hip/knee arthritis. Personally, I think it is truly amazing that they can literally take out an entire hip or knee that has been in your body for 50+ years, replace it with a high tech titanium joint, and have you walking on it in the same day!
When they first started to pioneer this surgery around 1970, the surgery took several hours and patients were sent home with a full leg cast for 8 weeks of bed rest. As you might imagine, all of the muscles in the leg wasted away to nothing and the recovery process was arduous. There were often complications, joint failures, and poor outcomes.
With advances in medicine and rehab the joint replacement is now a routine surgery that takes about 45 minutes. Most patients walk on both legs within 24 hours and are out of the hospital within 72 hours. There are rarely complications such as infection or joint failure and most patients achieve a good outcome within 6-12 months of rehab. Many people return to high level activities such as golfing, tennis, and hiking.
As physical therapists, we have all seen many patients over the years with hip/knee arthritis and after total joint replacement. With this experience, there is one aspect of this process that I feel is under-emphasized and in my opinion, the most important variable that predicts quality post operative outcomes: Pre-Hab.
What is Pre-Hab?
Pre-Hab is a term that we use to describe rehabilitation prior to an operation. Many hip/knee surgeon’s refer their patients for “Pre-Hab” before hip/knee replacement. Your knee is made up of bone, cartilage, ligaments, fascia and muscle. With severe arthritis, the cartilage becomes worn down leaving less padding in the joint causing inflammation/swelling and even damage to the bone. This process typically happens over several years which causes the ligaments, fascia, and muscle to weaken and stiffen.
With joint replacement surgery, the surgeon takes out the damaged bone and cartilage and replaces it with the artificial joint called an arthroplasty. However, the muscles, ligaments, and fascia surrounding the knee that is weakened and stiffened stays. It is these tissues, among other things, that we target with pre-habilitation in order to speed up the post-operative recovery.
How can I best prepare for my joint replacement surgery?
Most patients think because they have severe arthritis that the physical therapy cannot fix the damaged cartilage and bone so why do rehab prior to the surgery? The following is a list of things that pre-hab can improve which correlate with a faster and more quality outcome following joint replacement:
Joint range of motion (flexibility of ligaments)
Muscle flexibility
Fascial mobility (connective tissue pliability)
Reduced pain
Improved blood flow/circulation
Improved neuromuscular control (nerve signals controlling muscle)
Improved balance/stability/proprioception
Improved function: walking, stairs, squatting, exercising
Weight loss
Prevent atrophy (muscle loss)
Cardiopulmonary health (heart and lung function)
Reduce inflammation
Reduce swelling
What's next?
If you have questions about joint replacement or pre-hab, please call our office today to speak to one of our doctors of physical therapy -- as rehabilitation specialists, we are happy to help you decide what your next best steps are.
Call us today at 312-619-3556 to tell us your story & get started.