Prehab for your Total Knee or Hip Replacement

You’re about to have a total knee or hip replacement at a same-day surgical center. Hooray!

In most cases, you’re finally going to do something about that nagging arthritic pain in your joint that has been driving you CRAZY. You’ve met with your orthopedic surgeon, you’ve discussed the plan for surgery, and when to start your physical therapy after your surgery.

Many medical facilities have the option to do same-day-surgery for total joint replacements as long as you meet certain medical criteria. In addition, most places require that you have someone to help care for your basic needs for those first few days/weeks with you at your home.

If you check all of those boxes, you may be discharged and cleared to go home following an observation period once your surgery is complete.

In other words, there are no overnight hospital stays and you get to sleep in the comfort of your own home right away. Woohoo!

It sounds super convenient, and it certainly is, however…

Don’t Forget to Plan Out the Post-Op Details

There are a few things that are often overlooked in terms of being prepared to safely move about your home environment once you are discharged.

How will you get into your caregiver’s car after your surgery?

Have you ever walked with crutches a walker before?

How do you know if you are properly fitted to your chosen assistive device?

How will you get up that step into your home?

What about stairs in general? Which foot goes first? And what if you don’t have a railing?

How do you plan to get in and out of your shower or tub? What is the safest way to get in and out of bed? What’s the best resting position for your operative leg?

Are there exercises you should start doing right away to avoid complications? (The answer is yes, by the way)

Additionally, depending on the type of surgery you are having, there may be some important precautions to ensure the successful healing of your joint replacement. What are these precautions and what exactly do they look like in real life when you are trying to get dressed and shower?

What about the pain? Many people expect to be in pain, but how do you know if the pain you are experiencing is “normal”? And speaking of “normal”, what does “normal” wound healing look like and what are the signs of possible infection or complications you should look out for?

All of these questions (and more) are addressed in your pre-operative, or “prehab” physical therapy appointment and discussed with your physical therapist according to your unique circumstances and condition. The goal of a prehab visit is  to give you a personalized game-day plan for the few days following your surgery. We set you up for success.  This reduces the risk of overdoing it, underdoing it, or doing something that may jeopardize your safety at home and successful healing.

If you or a loved one are planning to undergo a total joint replacement at a same-day surgical center, here are important things to keep in mind.

Feel prepared for the big day and the post-operative recovery days to follow!

Establish Your “Why”

This is an extremely important first step in the prehab and rehab process. Sure, it’s the obvious first step in committing to surgery. It’s also the first step towards motivating yourself to be consistent in your healing process.

Generally speaking, there are a few main reasons you may be undergoing a total joint replacement for your knee or hip:

  • Most commonly, you have end-stage osteoarthritis in your knee or hip joint. This means the weightbearing cartilage surfaces in your knee or hip are worn away, damaged and inflamed resulting in injury to the bone. Subsequently, you are likely experiencing high levels of pain, stiffness, or discomfort.
  • You experienced a traumatic injury such as a fracture in an area that warrants the need for a total joint replacement. Your orthopedic surgeon is the expert in this case and will need to determine whether this is necessary for you or not based on your unique injury.
  • The blood supply to your joint has been compromised for another reason, and thus the joint needs to be replaced in order to prevent further damage.
  • Less commonly, there may be a tumor in the joint or bone resulting in the need for further stabilization from a joint replacement.

Regardless of the reason, if you are undergoing a total joint replacement, you are likely already in a significant amount of pain.

You’re looking forward to moving forward with an improved quality of life following your surgery. But what does that look like? What’s the deeper reason? What’s your true “why”?

It could be getting back on your surfboard. Maybe it’s playing with your grandkids with less limitation. These are the reasons that will keep you focused and optimistic as you set the framework for your recovery.

Learn as Much as You Can About Your Surgery Beforehand

Learning as much about the surgery as possible can be an advantage. It can aid in your recovery for two reasons:

  • You are better psychologically prepared for what to expect.
  • It will be easier to understand why certain exercises or precautions are relevant during your recovery.

These two things will be covered in depth at your prehab visit.

In general terms, joint replacement surgery involves removing damaged cartilage and bone, and replacing it with metal and plastic components.

Some of our patients have said watching a YouTube video of their specific total joint replacement surgery was helpful so they could see exactly what was happening inside their body during surgery, and what they were getting prepared to recover from.

But this isn’t for everyone! Beware if you have a queasy stomach – orthopedic surgery of any kind is like really technical carpentry work being performed on the human body.

If you’d rather save yourself a graphic YouTube search, read ahead to learn more about the basics. In addition, many doctor’s offices will provide you with educational material specific to the type of surgery you will be having. If they don’t, just ask!  They’ll be more than happy to provide you with it.

Here are the most common types of joint replacements we see in our clinic.

Common Joint Replacements in the Clinic

You’re not alone! We see these all the time.

1. Total Knee Arthroplasty

The entire cartilage and bony surface of your knee joint is replaced with metal and plastic.

2. Unicompartmental or Partial Knee Arthroplasty

In some cases, only part of the weightbearing surface in your knee is damaged to the extent that requires a replacement.

In these cases, only the damaged part of the joint, which is typically either the medial (inside) or lateral (outside) part of the joint is replaced with metal and plastic. The healthy cartilage, bone and surrounding tissues are preserved.

3. Total Hip Replacement

A hip replacement involves replacing the ball and socket components of the hip joint with metal and ceramic implants. This can be done a number of ways, each requiring slightly different rehabilitation protocols. The type of surgery you have is dependent on a number of factors according to your specific injury and anatomy, which your doctor will discuss with you in detail.

  • Anterior Approach
    • An incision is made in the front of your hip joint to gain access to your hip and remove the damaged tissue.
    • This is the most common type of hip replacement we see at our clinic.
  • Lateral (side) or Posterior (back) Approach
    • An incision is made on the side or back of your hip joint, and several muscles may need to be cut through or detached to gain access to the joint and remove the damaged surfaces.
    • This type of hip replacement involves more precautions, making it extremely important to go over in detail with your physical therapist how you will reach for things in front of you, tie your shoes, and get dressed. All of these things will be covered in your prehab physical therapy session.

At JACO Rehab, we also see many shoulder and ankle replacements, although these surgeries are not as commonly performed.

A Total Joint Replacement Surgery is a BIG Deal

Not only will you be recovering from anesthesia, but there is a significant amount of blood loss that occurs during these surgeries, resulting in you feeling wiped out afterward.

Additionally, people experience varying levels of post-operative pain and swelling. Your surgical team will work with you closely to monitor these two aspects of your healing. This makes it even more important to plan ahead and think of all of the challenges in your home environment that may come up for you after your surgery.

Hence, the necessity of a pre-operative physical therapy visit!

When it Comes to Walking with Crutches or a Walker, Practice Makes Perfect (NO REALLY, it does)

Even if you’ve used crutches before, using them after a total joint replacement may feel different.

In most cases, you will be permitted to put as much weight as you can tolerate through your operative leg after your total joint surgery, which may have not been the case with an injury you’ve had in the past. Depending on the type of past surgery or injury, using crutches when you are completely non-weight-bearing vs. partial weight-bearing is COMPLETELY different.

And did we mention that a total joint surgery is a really big surgery, and that you will feel really tired and out of it? This is why it is important to unwrap your crutches or walker beforehand, fit them to your height, and practice, practice, practice.

The more natural your crutch or walker feels beforehand, the less you will have to think about it afterwards.

During your pre-operative physical therapy visit, your therapist will fit your assistive device to your height, and then teach you how to walk with your crutches, walker, or cane.  They will show you different options for walking based on your pain levels and they will show you how to progress from two crutches to one crutch when the time is right. They will also show you how to use your crutches on stairs (up and down), and curbs. You will have the chance to practice these techniques in the clinic with them in simulated environments to ensure you are doing this correctly.

Follow your post-op precautions. We repeat: FOLLOW YOUR POST-OP PRECAUTIONS.

Depending on the type of surgery you have, there may be different precautions you need to follow to protect your joint and ensure proper healing after the surgery. Your therapist will discuss these with you in detail at your prehab visit. Following precautions will decrease the likelihood of aggravating tissues that are trying to heal, or worse, dislocating your new joint replacement.

Not only will your therapist discuss any precautions with you, they will review the most common places that people run into challenges when it comes to moving about in their home environment while maintaining their precautions. This may include sitting and standing up from low surfaces such as a toilet, or deep couch. This may also include getting in and out of bed safely.

They will point out things to avoid, like overusing the hip flexor muscles after an anterior approach hip replacement to decrease the likelihood of aggravating the healing tissue after your surgery.

Prehab is an extremely important part of your post-surgical success story!

How to Prepare for Your Prehab Physical Therapy Appointment 

The most important thing you need to do to prepare for your appointment is to observe your home environment beforehand.

Expect your therapist to ask you questions like: Do you have stairs?  How many? Is there a railing? What type of shower or tub do you have, and how high is the ledge? Are there grab bars to hold?

Do a check around your house and see if you have any particular questions about how to move about in your home environment after your surgery. Be thorough.

What to Bring

Make the most out of your prehab appointment! If able, please bring…

  • Your assistive device (usually a walker or crutches), which is typically provided to you by your doctor’s office at one of your pre-operative visits.
  • Any pre-operative material provided to you by your doctor’s office including exercise sheets, etc. Your therapist can ensure you understand how to properly perform these exercises
  • Comfortable, loose-fitting clothes you are able to exercise in. Your therapist will review the most important exercises to perform Day 1 to decrease swelling, prevent blood clots, and how to safely start getting your knee moving to prevent stiffness.
  • A pen and paper with a list of questions for your therapist.

The prehab visit will prepare you to safely return home the day of your surgery, reduce your risk of injury and set you up for success!

You may have a visit from a Home Health Physical Therapist the day following your surgery to answer anything else that comes up. He/she may show you how to progress your exercises before you begin your outpatient physical therapy sessions. The prehab visit will prepare you to safely return home the day of your surgery, reduce your risk of injury, and set you up for success!

Reach Out!

We wish you the best of luck with your upcoming surgery, and encourage you to reach out to us with any questions! Please call (808) 381-8947 or E-mail for more information.

Written by Cat Culver, DPT

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