Pre-op exercise may lessen the pain of joint replacement surgery

We are lucky to live at a time when we have pages of information and entertainment at our fingertips; a growing and widening array of food, fun and travel options; and healthcare that has extended our lives and made older age more comfortable. And we can get replacements for all sorts of aging body parts, including brand-new joints.

Hip replacements began in the 1960s and became more common in the ‘70s. The first knee replacement was undertaken by someone tragically named Themistocles Gluck, who used an ivory hinge and plaster of Paris for fixation. Gluck was actually a pretty remarkable, innovative surgeon, but that experiment didn’t go well.

Knee replacements moved well beyond use of elementary school science project materials in the 1970s and became refined in the ‘80s – and today, most of us know at least a couple of people who have new joints, typically as a result of osteoarthritis, which wears them down. So, when should you get a hip or a knee replaced, and what should you expect?

Dr. John Burger, an orthopedic surgeon with Bayhealth, practicing in Dover and Milford, specializes in hip replacement and other treatment for injury to the lower body. He said mobility and flexibility are often the best measures for determining whether to have joints replaced.

“It depends on a number of factors, but if a patient has severe arthritis and can’t move around or can’t tie their shoes or get in and out of a car, then probably they should consider replacement,” he said. “Also, surgery might be called for if more conservative treatment hasn’t helped, such as rest, injections, or taking Tylenol or anti-inflammatories.”

Deformity or stiffness and swelling are more likely with a problematic knee and may suggest a replacement is the best option, he said. Groin pain that might not seem related to one’s hips is often a sign of significant hip deterioration requiring surgery.

Apart from the conservative treatments one can try for knee issues, experts at Johns Hopkins say sufferers can consider other options, including injections of cortisone for pain, and hyaluronic acid to lubricate joints and improve movement, or orthobiologics, which promote healing using the body's own cells.

Other options, according to Johns Hopkins, include using supportive braces, radiofrequency ablation, which destroys nerves that send pain signals to the brain, or genicular artery embolization, a minimally invasive, outpatient procedure that reduces blood flow to the inflamed joint lining. A procedure called subchondroplasty that fills defects in the bone with a substitute material has been shown to be effective for both knee and hip damage in certain cases.

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Burger said partial knee replacements are more likely if just a portion of the joint has been worn or damaged, but not for more common osteoarthritis. 

“You can replace some of the parts of the knee individually, but most people need more extensive surgery than that. If a partial replacement is possible, it can feel like you have a good knee and you’ll face a much shorter recuperation,” he said.

The good news – and there is some – is that both hip and knee are typically outpatient surgeries, and you can go home the same day. Pain management and physical therapy for both also are steadily improving.

Burger said hip replacement recovery is generally shorter than the period for surgery on a knee – and knee replacement recovery usually results in greater and longer discomfort. He points to several factors that can affect recovery, most notably a patient’s general fitness and willingness to work on their recovery to regain strength and flexibility.

Sarah Schneider, a doctor of physical therapy working at Aquacare Physical Therapy in Lewes, said recovery happens in stages and also notes it generally takes longer for knee replacement.

“Typically, one doesn’t feel 100 percent until about a year post-op, but you’re likely to feel close to it after about the six- to nine-month mark, getting back range of motion, followed by strength, endurance and balance,” she said. “Remember that you’re not just recovering from a surgery; you are rehabilitating from potential weaknesses and compensations that have been developing for months, if not years, due to that problematic joint.”

She also notes that pre-surgery physical therapy can help speed post-op recovery – as will simply getting in the best possible shape. Aquatic therapy can be very useful prior to surgery, she said, and after incisions have healed.

Yale Medicine estimates knee surgery patients will typically use a walker for about two weeks, then a cane for up to six weeks. Patients often feel they have improved 60 percent by three months and 80 percent by six months, and fully recovered after a year.
 For hip replacements, University of Chicago medicine suggests that most people can return to their usual activities around two weeks after surgery. Full recovery and completion of physical therapy may take two to three months. 

RECOVERING FROM HIP OR KNEE REPLACEMENT

Pre-op fitness: Consider physical therapy or an exercise regimen that increases strength and flexibility.

Start moving after: Physical therapy usually begins the day after surgery. Walking, even with help, is important to prevent stiffness and blood clots.

Do your exercises: Stretching and strengthening exercises help you regain motion and strength. They may hurt at first, but the effort is worth it.

Ice and elevate: Use ice packs, and with knee replacement, keep your leg raised to reduce swelling and pain.

Stay active: Don’t sit too long. Take short walks several times a day.