WHO IS A CANDIDATE FOR JOINT REPLACEMENT SURGERY?

While joint replacement surgery is most often performed in older adults, it can happen at any age. When there is severe damage to the cartilage and/or bone of a joint, a partial or total joint replacement may be recommended. A total or partial joint replacement called a total or hemi-arthroplasty allows surgeons to replace the native bone and cartilage with a prosthetic joint. This is done to improve pain and function of the joint. The hip, knee, ankle, wrist, shoulder and elbow are the most commonly replaced joints but other joints such as the thumb, big toe and finger joints can also be replaced.

Not everyone who has cartilage or bone damage requires joint replacement surgery. Some people function just fine despite having lost some cartilage in the joint. For those individuals experiencing chronic joint pain that is not improving with medication, conservative treatments like physical therapy or lifestyle modifications, and that is impacting one’s function, joint replacement surgery may be recommended. Joint replacement can offer relief of symptoms like pain and stiffness in the joint and restore more normal levels of function.

Joint replacements may also be recommended to treat the effects of certain medical conditions that can damage the joint such as:

• Osteoarthritis
• Rheumatoid Arthritis
• Serious joint injuries (can lead to post-traumatic arthritis)
• Avascular necrosis
• Childhood joint abnormalities (can lead to joint problems in adults)

BENEFITS OF PREHABILITATION FOR JOINT REPLACEMENT SURGERY?

Patients expect to need physical therapy following their joint replacement surgery. Fewer patients, however, are familiar with how they can benefit from working with a physical therapist in anticipation of undergoing joint replacement surgery. Most people who undergo joint replacement surgery are experiencing significant pain and have likely decreased their exercise and activity in response to this pain. While the decision to decrease the level of movement and exercise to avoid provoking uncomfortable or painful symptoms is logical, it doesn’t necessarily put you in the best position for an easy recovery from surgery. These changes in activity combined with the joint damage already present, typically leads to joint stiffness and loss of range of motion, muscle weakness, decreases in neuromuscular control and impairments in overall endurance and aerobic fitness.

If the surgery isn’t an emergency, there are many ways that a physical therapist can help prepare you and your body for the upcoming procedure. The better condition the affected joint, the surrounding areas and let’s face it, your entire body is prior to surgery, the easier it is to return to your normal activities.

If you decide to work with a physical therapist to help with pre-op joint replacement surgery related issues, your entire treatment plan could consist of around 8-20+ different physical therapy for back pain sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

WHAT CAN YOU EXPECT FROM JOINT REPLACEMENT SURGERY PREHABILITATION?

My team of therapists will individualize a prehabilitation program just for you, however, there are many elements that are common across different prehabilitation programs. To help you gain a better understanding of what to expect, here is a list of some common goals of joint replacement prehab:
Set expectations: The idea of surgery can be quite scary. Getting to know your physical therapist before surgery will help build trust with them when it comes time for post-operative care. Having an idea of what to expect after the procedure can also ease some of your anxiety and help ensure you have what you need to support your recovery. Movement precautions or restrictions are common after joint replacement surgery, meaning there will likely be some movements, positions and activities that you will need to avoid for a while. Your PT can help you prepare for these restrictions and advise you on any equipment or modifications to your home that might be necessary. They can also help you understand what kind of help or support you will need from others and prepare you for how your body may feel after surgery.

Manage pain and inflammation: Pain and inflammation are natural side effects of chronic joint damage. They alert us that we need to protect the injured area and that the body is trying to heal itself. Chronic pain and inflammation can benefit from physical therapy to help reduce the pain response prior to surgery, especially if surgery is delayed for any reason. Learning strategies to manage pain and inflammation will help you stay comfortable and as active as possible in preparation for surgery.

Learn how to use assistive devices or adaptive tools: Depending on the joint involved you may be leaving the hospital with a new walker, cane, or crutches or a piece of adaptive equipment, and learning how to use them beforehand can be very helpful. Immediately post surgery, when you are still feeling the effects of anesthesia, and pain and stiffness are setting in, is not the best time to learn how to use an unfamiliar device that is meant to protect your recently operated-on joint.

Build or maintain strength and flexibility: While the surgeon has replaced the joint, which will ultimately improve your symptoms and get you moving again, the body will need to heal from the effects of the surgery before that can happen. Maximizing strength, soft tissue mobility and flexibility prior to the surgery can help decrease muscle atrophy and stiffness following the procedure which can ultimately quicken your recovery.

Prehabilitation for joint replacement surgery is an excellent choice for those wanting to get a head start on their recovery and to help improve their chances of a good surgical outcome. My team of therapists and I would love to help you prepare for your upcoming joint replacement surgery. Call the office at Evolve today to get started.