Getting Ready for Joint Replacement

I am going to discuss some tips for getting ready for joint replacement surgery.  The surgeons are very astute at discussing the technical aspects of an operation, what kind of installation would be used and what kind of prosthesis, but we are not very good identifying and clarifying what expectations the patient should have both before surgery to get ready and following surgery to have a best outcome and results.  I think many patients do not recognize how much work involves after a joint replacement.  Total knee replacements require a lot more rehabilitation in order to get range of motion than ever admitted whereas a partial knee replacement is a much easier rehabilitation because the incisions are smaller and scar tissue will be less.

Preoperatively, the best thing that patient can do is try to lose 5-10 pounds, and get in some basic shape cardio wise.  If the pain in the joint is too significant to walk then get in a pool and do some deep-water bicycle, running, or walking in the water in order to get your muscles toned and strengthened.  Doing some basic knee exercises (which we do have on our website) including straight leg raises, quadricep, hamstring curls and very importantly practicing the exercises your doctor gives you to do after surgery; practice them preoperatively everyday for the two weeks before your operation.  Learning to use crutches and getting your balance in tiptop shape will also help recovery.  If you are fearful of using crutches or a walker, ask your doctor one or two visits of preoperative physical therapy to not only teach you the exercises also to have you practice how to use crutches.  Make your house safe at home; try to make enough space to move around your downstairs or upstairs in bedroom so that you can get easy access to the bathroom or your favorite couch or chair.  Having pillows available to elevate your leg are important.

I cannot say enough about getting adequate vitamin D preoperatively.  There is an interesting study on total hip replacement that show patients that have a normal vitamin D level do better postoperatively than patients whose vitamin D is low before surgery.  Check into things such as railings for your bathtub or raised toilet seat.  These will make life much easier for bathing.

Many times in the hospital the patients except physical therapists to come around twice a day with their smiling faces and help you do your exercises.  With cost cutting in many hospitals now, the physical therapists may get around to see you but their primary goal is to get you walking, not doing your exercises such as your strengthening exercises or teaching you how to bend your knee at the bedside or sitting in a chair.  So, again practice these before surgery and be ready to do as much as you can on your own.  While the therapists will make sure that you are safe to go home from a walking standpoint or a stair-climbing standpoint, their only focus is now to get the patients out of the hospital sooner, once you are safe but not necessarily as far long as your rehabilitation used to be when you would stay in the hospital five to seven days.  Be your own physical therapy advocate postoperatively.  Ask your therapist what other exercises you can do.

-Lesley J. Anderson, MD

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