It may come as a surprise to you that total joint replacement patients are encouraged to get up and start moving around as soon as possible after surgery.
When you are medically stable, the physical therapist will recommend certain exercises for the affected joint. Physical therapy is a key part of recovery. The more quickly a joint replacement patient gets moving again, it is more likely that he or she will regain independence just as quickly. To ease the discomfort the activity will initially cause, pain medication is recommended prior to therapy. In addition, the physical therapist will discuss plans for rehabilitation following hospital discharge. Depending on your limitations, an occupational therapist may provide instruction on how to use certain devices that assist in performing daily activities, such as putting on socks, reaching for household items, and bathing. A case manager will discuss plans for your return home and will ensure that you have all the necessary help to support a successful recovery. If needed, the case manager can help arrange for you to have a home therapist.
The success of your joint replacement will strongly depend on how well you follow your orthopaedic surgeon’s instructions. As time passes, you should experience a dramatic reduction in joint pain and a significant improvement in your ability to participate in daily activities. Remember, however, that joint replacement surgery will not allow you to do more than you could before you developed your joint problems!
In the days following surgery, your orthopaedic surgeon, nurses and physical therapists will closely monitor your condition and progress. You’ll spend a great deal of time exercising your new joint and continuing deep breathing exercises to prevent lung congestion. Gradually, your pain medication will be reduced, the IV will be removed, your diet will progress to solids and you will become increasingly mobile.
Your physical therapist will also go over exercises to help improve your mobility and to start exercising the thigh and hip muscles. Ankle movements help pump swelling out of the leg and prevent the possibility of a blood clot. When you are stabilized, your physical therapist will help you up for a short outing using your crutches or walker.
Your physical therapist may use hands-on stretches for improving range of motion. Strength exercises address key muscle groups, including the buttock, hip, thigh and calf muscles. You can work on endurance through stationary biking, lap swimming and using an upper body ergometer (upper cycle). Physical therapists sometimes treat their patients in a pool. Exercising in a swimming pool puts less stress on your joints and the buoyancy lets you move and exercise easily.
When you are safe putting full weight through the leg, several types of balance exercises can help you further stabilize and control the hip or knee. Finally, you will work with a group of exercises to simulate day-to-day activities, such as going up and down steps, squatting, rising up on your toes, bending down and walking on uneven terrain. You may be given specific exercises to simulate your particular work or hobby demands.
Hip patients begin physical therapy soon after waking up from surgery, with your physical therapist helping you move from your hospital bed to a chair. By the second day, you’ll begin walking longer distances using your crutches or walker. Most patients are safe to put comfortable weight down when standing or walking. However, if your surgeon used a non-cemented prosthesis, you may be instructed to limit the weight you bear on your foot when you are up and walking. Hip patients will also do exercises to tone and strengthen the thigh and hip muscles, as well as ankle and knee movements to pump swelling out of the leg.
Whether you are sent directly home or to a facility for rehabilitation will depend on your physician’s assessment of your abilities. In general, if you live with someone who will be assisting you, discharge home is the usual procedure. The case manager will make your arrangements for further home or outpatient physical therapy. Most patients can go directly home if it is deemed safe by their surgeon and physical therapists.
If you live alone or are in an environment at home where your safety is a question because you have not achieved your discharge goals, you may be recommended for placement in a rehabilitation center. These facilities are usually available to a patient for a 3-5 day stay, with emphasis on returning the patient home in a short period after aggressively addressing any problems with patient independence. If you live alone or are not progressing rapidly enough in therapy sessions and it is unlikely you will be able to do so in a rehab setting, a sub-acute facility may be recommended for a longer period of recuperation. Insurance coverage for these post hospital stays vary according to condition and plan and will need to be discussed by the patient, the case manager and the insurance company as warranted.