The Role of Rehab: Improving the Joint Replacement Patient’s Level of Function

If you’ve suffered from the discomfort and pain associated with bad knees or unstable hips, joint replacement surgery may be an option. However, surgery is just the first step of the journey towards healing.
"When patients start researching joint replacement, most are surprised to learn that it’s a process involving both surgery and rehab," said Shelley Wichmann, PT, a physical therapist at Missouri Baptist Medical Center. " Joint replacement surgery isn’t a quick fix. "

Goals of Rehab

The patient plays a key role in the work of physical rehabilitation. Physical therapy helps joint replacement patients recover more quickly from surgery, while maximizing the results of their new joint.
Generally, the goals of rehab for joint replacement patients include:
• Improving joint range of motion
• Strengthening the joint and surrounding muscles
• Easing pain or swelling
• Monitoring progress and symptoms
• Facilitating patients back to their normal activities of daily living
• Assisting patients to an improved level of function

"As physical therapists, we customize every rehab program to fit each patient’s individual needs, depending on his or her lifestyle, capabilities and goals," said Wichmann. "Ultimately, the goal of any rehab program is to maximize function. We strive for patients to achieve an improved level of function compared to their baseline prior to surgery."

A Patient's Perspective

When 71-year-old Creve Coeur resident, Tom*, elected to undergo knee replacement surgery in April 2014, it wasn’t a decision he took lightly. He had been battling terrible knee pain for years, which significantly limited his active lifestyle. He could only walk for short periods of time before the pain forced him to stop.

"I was frustrated by the constant pain I felt in my knees," said Tom. "It was interfering with the simple daily activities I had always enjoyed. I didn’t want to spend my retirement years sitting on the sidelines and watching life pass me by."

After trying cortisone injections and looking into other medications, Tom knew knee replacement would be the best option for him. Richard Johnston, MD, an orthopedic surgeon on staff at Missouri Baptist Medical Center, thoroughly prepared him for what to expect with the surgery as well as rehab.

"Given his good health and active lifestyle, Tom was an ideal candidate for knee replacement surgery," said Dr. Johnston. "Patients who lead active lives and maintain a healthy weight before joint replacement surgery tend to experience better outcomes with their new joint."

Dr. Johnston walked Tom through the entire process, showing him an educational video that outlined the surgery and rehab. He also introduced Tom to Wichmann, who would become his physical therapist.
"Both Dr. Johnston and Shelley made me feel much more comfortable about my knee replacement," said Tom. "I knew exactly what to expect from the surgery and rehab and what would be expected of me."

Pre-Surgery Rehab

Tom and Wichmann met and began a pre- and post-surgical outline. This was one of several planning meetings to better prepare Tom for his surgery and therapy journey.

"In an effort to build up muscle strength and maximize overall outcomes, our joint replacement patients begin rehab in the weeks leading up to surgery, receiving pre-operative testing and education, including basic exercises," said Wichmann. "For most patients, exercising before surgery is rather limited due to the pain in their joints, so this pre-op rehab program helps stimulate those key muscles and better prepares them for what they’ll be doing in therapy."

Under Wichmann’s direction, Tom completed the 30-day pre-surgery rehab program at Missouri Baptist. Dr. Johnston also had him follow a high-protein diet, which included vitamin C and other minerals to help build up his immune system and muscle prior to surgery.

"If you’re going to do something, then take the time to do it right. That’s why we feel very strongly about pre-operative preparation for joint replacement patients," said Dr. Johnston. "Those who complete the pre-op rehab program tend to have fewer complications and heal better and faster. They also have less anxiety about the entire process."

Inpatient Rehab During Hospital Stay

Following joint replacement surgery, movement is critical to start the healing process. In fact, most patients are encouraged to move around shortly after surgery. It could be as simple as sitting on the edge of the bed, standing up, or even taking a few steps with some assistance.

"After my surgery, I was up and walking around my hospital room with the help of a walker," recalled Tom. "I didn’t want to waste any time, because I wanted to get the most out of my new joint. That was my motivation to get moving."

In addition to individualized physical therapy sessions, patients join in daily group classes that teach basic exercise, home safety, and pain control techniques for successful healing post-surgery. Patients also receive occupational therapy, which addresses each patient’s activities of daily living, ensuring the patient is equipped with everything he or she needs for a safe transition home.

Outpatient Rehab Program

Upon discharge, most patients are assigned a six-week outpatient therapy program, which includes one-on-one sessions with a physical therapist for one-hour, two to three times per week. This program uses benchmarks that evaluate range of motion, strength and mobility to ensure patients are meeting their rehab goals accordingly.

Another benefit of an outpatient rehab program is that the physical therapists are able to closely monitor their patients’ new joints for any unusual swelling or movement in between doctor visits. With their specialized training and experience, they know what to look for in terms of issues. "We’re able to reassure our patients about what’s normal and what’s not," said Wichmann.

Tom's Rehab Therapy

Tom was discharged from the hospital on a Friday and started his outpatient therapy program with Wichmann at Missouri Baptist the following Monday.

"Tom skipped home health and opted for the immediate outpatient rehab," said Dr. Johnston. "We’ve found that patients who go this route often get better faster. The focus is then on their rehabilitation and not illness."

Wichmann started Tom’s therapy with simple exercises, which he had previously learned in the pre-operative consultations. Tom graduated to more advanced exercises, including stretching, strengthening, balance activities, and gait training. Wichmann also discussed appropriate exercises to do at home and after therapy, including walking and gym programs as well as other lowimpact recreational activities.

Fortunately, Tom’s hard work paid off – he met the therapy benchmarks in record time, concluding his outpatient rehab program after only five weeks.

"Therapy is a critical part of the recovery process," said Tom. "It’s essentially a fulltime job for those first six weeks. However, the payoff is completely worth it."

Tom’s first knee replacement and rehab went so well that he decided to have his other knee replaced six months later. With the second joint replacement, Tom knew what to expect and was committed to doing the rehab necessary to maximize his results. Today, he enjoys an active, pain-free lifestyle of walking, cycling and keeping up with his grandkids.

*patient’s last name omitted for privacy

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