Sunday, August 18, 2013

How to Recover and Thrive Post Joint Replacement

How to Recover and Thrive Post Joint Replacement

How to recover and thrive post joint replacement is not different than an athlete returning to play after sustaining an injury. This athlete is faced with a change of activity level, loss of normal play, and the trial of post-operative care in the form of physical therapy, and compliance to a medical treatment plan. The progression of return to activity following Joint Replacement Surgery (JRS) requires the same preparation, focus, discipline, compliance and patience as athlete. It Takes a Positive Mindset.

Baby boomers in 2013 are of at the age of 49-67. This is the age when we, yes I am a Baby Boomer, are experiencing health effects of aging. Arthritis and degenerative joint changes are a leading health condition reported by this group. The fact is that young people are requiring joint replacement surgery due to advanced degenerative joint disease. The other fact is that our older population, while aging, is maintaining an active lifestyle by traveling, participating in sports and work activities, and participate in an active social life. Joint replacement is often elected as a treatment of joint to manage pain and decline of functional ability. The ultimate goal is to thrive in our aging years.


Hip and Knee Joint Replacement by Doc Mike Evans







Preparation for Replacement

The benefit of going into a JRS is you can prepare for the event. Your surgery is elective, and you have the opportunity to prepare for a successful outcome. The pre-operative phase of JRS requires pre-habilitation. This phase is a preparatory phase that gets the body, and mind, prepared for, and ready to meet the demands of the surgery.


It is much easier to learn how the knee is expected to move and what exercises you will be expected to perform on a daily basis after the surgery, if you prepare in a pre-operative state. This preparation must include increasing fitness - Randy Bauer, Bauer Physical Therapy

It is also a time to address your exercise capacity and body weight. These two issues, body weight and fitness level, are important predictors of how you will recover from surgery and restore your physical capacity.

Pickle Ball, Any Body


Your engagement in activities such as golf, tennis and pickleball, swimming and walking are all possible post joint replacement. Keeping in mind the normal post-operative obstacles of pain, limited mobility and a decline in functional mobility and gait, the return to your desired activities and sports will not be easy, but definitely possible with hard work and compliance to your treatment plan.

Thrive Post Joint Replacement Surgery


Pain Management is an important phase of the post-operative course of treatment. Limiting pain post-operatively is important for achieving successful outcome following joint replacement.The surgery is an open procedure and requires some major work performed by the Orthopedist. Pain is to be expected. Following a pain management program prescribed by the physician and instructions by your physical therapists are essential in getting through this phase. "Cold packs are your friend", I tell my clients. Cold packs are beneficial in reducing pain and inflammation. Due to the nature of the surgery swelling is expected, and cold packs are useful in reducing the swelling that causes pain and limitation of joint mobility.


Tools: Polar Ice Standard Knee Wrap

*Ice pack is best applied to hip with a standard ACE Wrap


Balance & Strength

Restoration of Joint Range of Motion will begin almost immediately post-operatively. There are protocols that are offered by your Orthopedist and Physical Therapist that are based on the exact procedure that was performed. Exercises will include passive range of motion with assistance of your PT and progressive assistive exercises that help in restoring your range of motion. The improvement of joint mobility must be given importance early in the recovery process. As your joint mobility improves so to does your circulation in the extremity. A great mode of restoring joint mobility is a stationary or recumbent bike. Initially the bike is used for range of motion alone. I find that normal mobility on a stationary bike is gained once you achieve >100 degrees of knee flexion. It is of particular emphasis to gain full knee flexion in the case of a Total Knee Arthroplasty (TKA) early in the post-op course. This is aided by avoiding placement of a pillow under the knee. Instead, place the pillow under the foot allowing the knee to fully extend for multiple periods of duration through the day.

Tools: Anti-Burst Gym Ball (55-75cm)


Increased Strength and Endurance of the lower extremity muscles, and upper extremity muscles are introduced to improve the functional demands of increased daily activities. Strong upper extremity muscles come in handy when using gait aides (walkers, crutches and cane). As the lower extremity muscles are strengthened there is greater capacity to withstand weight bearing tolerance of the lower extremity. The use of a gait aide, such as a crutch, will allow for this normal return to weight bearing, and provides some strengthening effect. Strengthening the muscles to perform normal activity will include open chain exercises(Example: Straight Leg Lifts) and progress to Closed Chain Exercises (Example: Step ups and short squats). This will carry over to improved ability to negotiate steps and stairs at home, as well as increasing your walking duration. An excellent mode of exercise post-JRS is a stationary bike. The stationary bike allows for range of motion, muscle endurance and progressive resistance to muscles for strengthening.

Tools: 


Improved Balance and Proprioception is part of the post-operative course of any joint replacement surgery. The effects of surgery change the way you perceive motion and weight bearing sense in the joint. Gains in your balance and joint awareness are provided through core stabilization and protective activities that challenge you in an unsteady environment. It is important to restore these functions of balance to prevent the likelihood of falls in and out of the home. Improved balance will be of benefit as you return to your active life style; playing golf, gardening or household chores.

Tools: 


Normal Gait begins with increasing your weight bearing tolerance post-operatively. Assistive devices such as walkers, crutches and cane are helpful at restoring your normal gait pattern, weight bearing and ambulating over varied terrain. Returning to full weight bearing with normal gait allows for greater function in all of your daily activities, as well as an active lifestyle, and this is of great importance to your total well-being. A normal goal of physical therapy is to walking 1-mile within two months post-op joint replacement without gait assistance.

Tools: 

Functional Recovery and Training begins with basic daily activities. This includes getting out of bed, bathing and dressing. In essence, you are starting from scratch. Learning new strategies to do the basic of daily activities progresses quickly to more advanced activities. It is not long before you are practicing elements of your golf swing, side-stepping across the floor to mimic your favorite dance step, or to practice your moves on the court. Going into a JRS requires preparation, and understanding that it will not be easy and some patience and hard work will be required. Teamwork is required from medical professionals, physical therapists, and those that are close to you to help your along the way. Consider some of the tools that can be used to help regain your functional capacity, and before long, you will be thriving, and returning to play.

Before engaging in any exercise and activity pre-operative or post-operative Total Joint Replacement it is advised that you consult with your Medical Specialist. The above activities can be used with the approval of your medical and rehabilitation specialist. 


References: 


Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic CenterAditya V. Maheshwari, MD, et al, Clin Orthop Relat Res. 2009 June; 467(6): 1418–1423.