Total Joint Replacement Rehabilitation - An Overview

Introduction:

Total joint replacement is a procedure in which the damaged joints are surgically removed and replaced with a prosthesis, which usually is made up of metal, plastic, or ceramic material. The prosthesis, in turn, acts like the joint and restores normal form and function. Total joint replacements are done mostly on the wrist, shoulder, hip, and knee. Total joint replacements are essential for improving longevity, biocompatibility, restoration of normal structure, minimization of risk, and maximization of function. Care should be taken to protect the operated tissues post-operatively to limit complications such as muscle injury and dislocation. Understanding the soft tissues involved during operation is essential for targeted rehabilitation.

When Is Total Joint Replacement Needed?

It is done under the following conditions:

1. Joint pain and stiffness.

2. Pain aggravated on physical therapy and in patients unresponsive to conventional therapies.

3. Joint disorders like osteoarthritis and rheumatoid arthritis.

4. Fractures of the hip, knee, shoulder, and ankle.

5. Reduced range of motion that is painful.

6. Unimproved swelling even after taking medications.

7. Rare conditions like osteonecrosis in which the blood supply to that tissue is lost, resulting in tissue death.

How Is Total Joint Replacement Done?

The knee joint is removed, and the damaged surfaces are replaced with the prosthesis. The prosthesis is either cemented using surgical cement, or it can be non-cemented, which is attached to the bone through a porous region in which the bone regrows after some days.

What Should Be Expected After Arthroplasty?

The joint is fully healed within three to six weeks, and the patient can move normally after the surgery. In some patients, the healing process might take up to a year. Risks are unavoidable in any surgery. Possible complications after a total joint replacement are bleeding, infection, blood clots, fracture, pain, stiffness that does not go away, loosening, and dislocation of the new prosthesis. The new prosthesis may sometimes fail, and surgery may be indicated. Nerves and arteries can be injured during the procedure. An underlying medical condition could delay the healing process in some patients. Delayed healing can occur if the patient is bedridden or sedentary. Continued physical therapy and exercising daily can improve recovery and restore function faster than expected.

How to Recover From Total Joint Replacement?

Utmost care should be given to the operated area to prevent further damage. Stress on the joint replacement should be minimized to avoid excessive wear and tear that would reduce the longevity of the surgery. Correct use of walking aids is encouraged to reduce stress on the affected area. Only certain activities are encouraged after joint replacement.

What Long-Term Activities After Total Replacement of the Hip or Knee Are Advised?

What Exercises Are Prescribed for Total Joint Replacement of the Hip?

The intensity of the exercise should be adjusted so that it is painless but still improves fitness. Running and jumping should be avoided, and shoes should be cushioned. Joints should not be placed at the extremes of motion.

A) Phase One (Hospital Discharge): This is the post-operative phase, and the main goal would be to reduce swelling and control pain. The healing tissue is protected, and basic stretches are taught to restore a normal range of motion. Educating the patients regarding the prevention of dislocation of the operated joint. Walking using crutches or a walker is recommended.

1. Heel Slides: This is done by asking the patient to lie down near a wall and place the affected knee parallel to the wall and the unaffected knee a little lower. The patient is asked to gently slide down the affected leg and hold it for ten seconds. Then it is slid upward using the unaffected leg.

2. Ankle Pumps: This is done by asking the patient to lie down with both legs extended. The patient is asked to slowly flex the toes upward and then return to the normal position. This is repeated in a continuous motion.

3. Quad Sets: This is done by asking the patient to lie down with the knees of both legs extended together, and a towel is placed under the affected knee. The patient is asked to push the back of the knee on the towel by exerting pressure for five seconds and then asked to relax.

4. Hip Abduction: This is done by asking the patient to lie down with the knees of both legs extended together and toes pointing to the ceiling. Now gently slide the affected leg away from the body by keeping the legs straight. Then bring it back to the original position.

5. Knee Extension: This is done by asking the patient to sit straight in a chair with their legs touching the floor. The patient is asked to lift the affected foot slowly and extend the knee until it is straight. Hold this position for five seconds and return the foot to the original position.

B) Phase Two (Mobility): This is done after six weeks of surgery. In this stage, the patient is asked to walk using assisting devices like crutches or a walker, progressing to a cane. Continue doing the quad sets, hip flexion, and extension exercises. Weight-lifting activities also can be done. Stationary biking with minimal to no resistance.

C) Phase Three (Strengthening): This phase is done in six to 12 weeks to restore strength. Avoid activities that require repeated twisting. Continue with phase two exercises and add increased resistance to workouts.

D) Phase Four (Advanced): This is done after 12 weeks. Continue to improve strength to improve function. Dislocation precautions must be followed, and avoid repetitive lifting and high-impact activities like contact sports. Perform exercises daily to improve flexibility.

How Is Management of Rehabilitation Problems After Total Knee Arthroplasty Done?

1) Difficulty in Full Extension of the Knee:

• Patients are asked to start walking backward.

• The therapist performs passive extension with the knee off the table, with and without weight placed across the ankle.

• The passive extension is also done by the therapist using a towel roll placed under the ankle, and the patient is asked to push downward with or without using a weight.

• Electrical stimulation is done for muscle re-education by passing electricity in the affected area through electrodes in a controlled manner.

2) Delayed Knee Flexion:

• The therapist passively stretches the knee into flexion.

• Wall slides for gravity assistance. This is done by asking the patient to lie down near a wall and place the affected knee parallel to the wall and the unaffected knee a little lower. The patient is asked to slide down the affected leg gently, and then it is slid upward using the unaffected leg.

• Stationary bicycling is recommended. This can be done first in the backward direction, and gradually if the range of motion is better and painless, it can be done in the forward direction.

How Can a Total Joint Replacement Be Prevented?

• By frisk intervention if there is joint pain.

• Following conventional therapy like physical therapy and Cortisone injections.

• Reducing weight in the case of obese patients.

• Exercise modifications include aerobic exercises like swimming, jogging, and walking.

• Taking the necessary precautions to avoid joint tears.

• By consuming an adequate amount of nutritious food and taking medications regularly in case of underlying conditions.

Conclusion:

Total joint replacement is important as it improves the quality of life. The patients benefited from the rehabilitation program by learning to use the new prosthesis for normal movements involving the joint. Recovery from the surgery takes time, but it can be sped up by undergoing rehabilitation. Physical activity and physical therapy can accelerate the healing process and reduce pain levels. Extra care has to be taken while using the operated joints as the chances of re-damage are more. In order to reduce post-operative complications and restore function, rehabilitation is indispensable.