Joint Replacement Preparation; Enhances Outcomes

Caitlin Woodyard PT, GCS (Geriatric Certified Specialist)
Marcus Daly Rehabilitation Department
1200 Westwood Drive
Hamilton, MT 59840

Do you have a joint that won’t stop hurting, stiffness that limits your activity, or a limp that leaves you walking at the back of the pack? Maybe you will be one of the more than one million people who choose to have a joint replaced each year in the United States. The decision to trade out your arthritic hip or knee for a new model is not made lightly by you or your healthcare team. You will likely spend many hours with your family and physician discussing your options and pondering if it is right for you. Just as this decision requires thoughtful consideration, so does the preparation for your own joint replacement journey. Continue reading for insight and suggestions for a successful experience.

Are you facing a joint replacement surgery at your peak fitness level? Probably not, years of arthritis typically results in pain with physical activity, which may have led you to decrease how much you walk, work in your garden, ride your horse, hike, fish, or go to the gym. Decreased activity or exercise can result in less joint range of motion, flexibility, and strength. Maybe you have noticed that your knee no longer straightens all the way or bends as far as it used to; that is decreased joint range of motion. If it is difficult to put your shoes on, you are experiencing limited flexibility. Has your knee ever buckled on you, causing a fall or a near miss? Do you feel shaky or weak after climbing one flight of stairs? These are some symptoms of decreased strength.

Physical preparation before surgery improves your ability to move your body with less pain and more ease after your surgery. While your results from surgery will improve with preparation, it is important to consider how your current medical conditions may determine what is safe for your body. If you’ve recently discussed exercise with your physician and they have recommended it to you without reservation, there is no reason to wait. However, if you have a heart condition or difficulty breathing, if you take multiple medications, or if you have a new concern you haven’t discussed with your doctor, it would be wise to see them first to discuss safe types of exercise for you.

Your primary physical goals in preparation for a joint replacement are increasing the joint range of motion, muscular flexibility, and muscular strength in your surgical joint and throughout that leg. Your secondary physical goals are increasing the strength of your non-operative leg, both of your arms, and your core. Your non-operative leg will be your workhorse as you are recovering from surgery; it needs to be strong enough to support you as you gradually are able to bear weight on your surgical leg. Use of a mobility device such as a walker, crutches, or a cane are common for weeks to months following a joint replacement; make sure that your arms are prepared for the work that will be asked of them during this task. Finally, your core muscles- think primarily abdominal and back muscles- do work constantly throughout the day for your breathing, posture, and balance. Preparing them will help you to move better and decrease your risk of spine injury throughout your recovery.

If you are typically a self-directed and self-motivated individual with a good grasp on exercise basics, you may be able to prepare yourself for surgery. However, if you aren’t sure where to start, seek out the advice of a physical therapist or other exercise professional. Guidance through specific, safe, and progressive exercises will help you reach an optimal physical condition prior to scheduling your surgery date. And remember that your goals are unique to you- while your friend or spouse’s goal may be walking a couple miles per day, it is ok if your goal is to walk to and from your mailbox. Your starting point and your goals will be individual and any progress is a positive result!

In addition to preparing your body for your surgery, it is helpful to prepare your home. First, consider the entrance to your home; do you have stairs to negotiate? If so, do you have a rail to hold while you climb those stairs? Consider installing a basic handrail to ensure your safety and stability while you come and go from your home- during your recovery and the coming years of aging. Second, do you have clear pathways in your home or are you stepping over pet beds, catching your toe on your favorite throw rug, and stepping around your favorite antiques? If so, consider clearing your paths and decreasing tripping hazards so you will be able to navigate between bedroom, bathroom, kitchen, and living areas with a walker. This will assist you in maintaining your independence and safety in your own home following your surgery.

Physically preparing for surgery is crucial; your body will thank you. Mentally preparing is equally important. Have you thought through what recovery with a newly replaced joint may look like? Your surgeon and nurses will help you through the details of medication management following your operation to facilitate good pain control. Physical and occupational therapists in the hospital will help teach you basic mobility and daily living tasks- getting dressed, getting in and out of bed and chairs, on and off the toilet, in and out of the shower, walking with a mobility device, and balancing while you brush your teeth or feed your dog.

After a few days in the hospital, you will be ready to return home! Aren’t you glad you put that rail in by your stairs and have a clear path to your favorite recliner? However, don’t get too comfortable. Just as you put in many hours of hard work preparing for surgery, there are many more ahead. You will be discharged from the hospital with your first set of exercise homework but will need to pursue continued physical therapy in an outpatient clinic to ensure you meet your long term goals. With thoughtful preparation, hard work, and a positive attitude, you are on track to a successful recovery.

This week’s community health column is brought to you by Marcus Daly Memorial Hospital. For questions and or comments, please contact Caitlin Woodyard PT, GCS at the Marcus Daly Rehabilitation Department at 1200 Westwood Drive, Hamilton MT, 59840 or call 406-375-4570. Working together to build a healthier community!

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