Total Joint Replacement: What You Should Know (Part 1)

So you’re getting a total joint replacement, particularly of the knee or hip? You’re either already scheduled, or at least thinking about taking that next step.

Up to this point, you have probably been dealing with regular pain, difficulty with certain movements, and not getting to enjoy hobbies, work, or play in the same way. You may have noticed that your walking pattern has changed. Maybe you now rely on a cane to help you get around. You may have noticed some ached and pains in other areas, like your low back or feet, as a result of moving differently. Your doctor is recommending a total joint replacement.

Now what? Throughout our 3 part series about total joint replacement, we will be talking about:

• “Pre-Hab” or Rehab before surgery – why it can be a great option to help with better recovery after surgery.
• Recommendations for setting up your home to make things easier once you’re back from surgery.
• Common recommendations for equipment that can make walking and normal self-care tasks easier.
• What to anticipate during your hospital stay.
• Options for physical therapy and rehabilitation after discharging from the hospital.
• What to expect during your recovery.
• and other general recommendations.

We hope these next few blog posts are helpful to you!

Now let’s get started….  

“Pre-Hab” or Rehab Before Surgery

First of all, doing some physical therapy prior to surgery can be a great option for most people. It gives you an opportunity to build up as much muscle strength and stamina going as possible before going into your surgery. It often helps people do better during the recovery process. Doing some prep work can also help to minimize any other aches and pains that have developed prior to surgery, so you don’t have to worry about them afterwards. All in all, it gets you going on a good start.

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A study published in 2014 by the American Academy of Orthopedic Surgeons took data gathered via Medicare claims from nearly 5,000 people who had had either a total knee or total hip replacement. They compared information for overall use of therapies and their cost. They found that those that did pre-habilitation showed a 29 percent reduction in post-operative care use, saving an average of $1,215 per person. Most individuals that used pre-hab only needed a couple of visits to meet their needs. Your doctor may already recommend this option to you, or you can ask him or her about it.

You may also hear about a variety of other options before surgery, with the hopes of delaying that surgery. Options may include corticosteroid injections, hyaluronic acid injections, non-steroidal anti-inflammatory medications (NSAIDs), braces, insoles, etc. According to a 2017 study by the American Academy of Hip and Knee Surgeons (AAHKS), only three pre-surgical options were recommended for use. These included NSAIDs, tramadol, and physical therapy. This same study found that if people stuck to these three recommendations, rather than trying many others on the list, people could find up to 45% overall cost savings for the treatment of knee osteoarthritis.

Home Set Up & Making Arrangements

It’s also a good idea to get things set up before you go into surgery. This can include arranging your home in a more mobility-friendly way, picking up supplies and equipment, and scheduling help at home.

One helpful idea is removing any throw rugs that you have. When you’re still new to the method of walking after your surgery, you don’t want to have to worry about tripping on a rug.  Also make sure that you have a cleared path along any major routes through your house, like to your bedroom, bathroom and kitchen. You will likely be relying on a walker or crutches, so each path should be wide enough to accommodate walking with a device.

If you have stairs inside your home, be prepared to have a back-up plan for staying on your main level, in case you have difficulty with stairs. Many people are able to practice stairs while still in the hospital so that you feel confident with them before going home.

It’s never a bad idea to think of your options ahead of time, so that you’re not left scrambling when you’re getting sent home from the hospital.

Helpful Equipment

Lastly, there are various types of equipment that you may find beneficial once you’re at home after your total joint replacement. Most items are available for rent or purchase. I always recommend purchase, because you never know if you or a family member will need the same thing in the future!

• Walking aides: First of all, most people after a hip or knee replacement will rely on a walker, if only for a short time. Some people are able to progress to crutches before they head home from the hospital. 
  • Front-wheeled walkers or crutches may be covered by your insurance company, although many companies will only cover one device every 5 years. Most insurance also see items like a four-wheeled walker as a “luxury item”, and will not cover them at all. 
  • If your insurance will pay for something when you have your surgery, there is often someone at the hospital, like a physical therapist or case manager, who can order one for you.
• Bedside commode or raised toilet seat:
  • It’s amazing how challenging it can feel to get up and down from the toilet after these surgeries! This device helps bring the seat up to you, so that you’re not having to work so hard.

• Grab bars:
  • It’s important to think about an extra level of safety when it comes to getting in and out of the shower after surgery. It’s also great if you’re having trouble putting a lot of your weight through your leg, or if you’re just not allowed to because of the surgery done.
  • The bar will give you something sturdy to hang on to, whether you have a walk-in shower or a tub/shower combo.
• Shower chair: 
  • This device is particularly helpful if you have a tub/shower combo, but can be helpful with a walk-in shower as well. It’s not unusual for people to initially feel like it takes a lot of extra energy to bathe after these surgeries.
  • This type of seat will allow you to be safe in a seated position, will allow you to have a seated break if you’re getting tired or feel like your balance isn’t great, and can make a transition over the edge of a tub a bit easier.
• Detachable shower head: 
  • Another device to help you with bathing while you aren’t as mobile as normal.
  • This is particularly helpful if you’re using a shower chair.
• Sock aide: 
  • One of the simple things that we often don’t think about when going into a total knee or hip replacement surgery is how we’re going to get socks and shoes on.
    • If you’re having difficulty bending your knee or hip, this device can be a life-saver. It can spare your helper at home from needing to get down low to help you.
  • There are several kinds of sock aides, including the style included on the link here. There is another style that just sits on the floor, and you push your foot through. I’ve had several patients say that they prefer the style with the ropes to pull on, as pictured.
• Reacher: 
  • This is often helpful for things like get pants and underwear on. It can also be used to reach for things that you’ve dropped.
  • This should not be used for large or heavy items. You also need to be careful with using this for anything overhead, unless it is something like a light piece of clothing.
• Long shoe horn: 
  • Again, getting shoes on can be a challenge, and this helps bridge that gap.
• Shower sponge: 
  • This helps you reach your lower body in particular, which can be a challenge with limited mobility immediately following surgery. 

We’ve talked about how to prepare before going in to surgery for a total joint replacement. Our next blog will talk about what to expect during your hospital stay and options for after you discharge from the hospital.

 

 

 

Article author, Alyssa Arms, PT, DPT, OCS holds a Doctor of Physical Therapy (DPT) degree from the University of Colorado Anschutz Medical Campus. She later obtained a Board Certification as an Orthopedic Clinical Specialist (OCS). She is also the President and Owner of Back in Step Physical Therapy in Centennial, Colorado, and is an instructor at her PT alma mater.