While hip and knee replacement surgeries are super common, it's important to have a thorough understanding of what to expect before, during, and after surgery. While these surgeries may seem a dime a dozen, the reality is that there are things you can do before surgery to have a better outcome, that surgery itself is not exactly a light walk in the park, and that rehab after surgery can vary dramatically depending on where you go and whom you see.
It seems that everyone at least knows someone that has had a knee replacement or hip replacement or has had one personally. They're super common – a registry-data paper published in 2022 reported 2.4 million hip and knee replacements were performed and reported to this one registry from 2021. That's a lot of new hips and knees...
It would appear that these surgeries being so commonplace can contribute to a variety of issues and concerns for patients, ranging from frustration from not knowing what to really expect during and after surgery, uncertainty of what can be done safely before and after surgery, and not knowing what to look for with rehab.
Preparation starts before your joint replacement
Once scheduled for a joint replacement, many people may feel resigned to simply accept their symptoms and limitations at face value and await surgery. We have started to see a slow-growing trend of people seeking out or surgeon's recommending "prehab" – in other words, seeing a physical therapist to try to address some of your impairments and limitations. These may include addressing factors that have been identified as risk factors that may make your recovery after surgery a bit more challenging (for example, reduced range of motion, greater magnitude of loss of strength, etc.).
Generally speaking and in synthesizing findings from a few different prognostic studies, factors like a lower BMI, greater range of motion, and greater strength/levels of function appear to be linked to better outcomes after surgery. While there, of course, can be limits to this methodology of research – if you have a BMI of 18 before considering surgery, losing weight probably shouldn't be high on your radar – this suggests that there are things that you can actively try to address before surgery to make your time after surgery that much easier. There are a variety of studies that support the roles of manual therapy (in essence, hands-on interventions performed by a physical therapist) and specific exercise to help with pain, range of motion, and function for hip and knee osteoarthritis. People often want a "recipe" – the specific things to do to yield results – but the reality is that exercise prescription should occur along something of a sliding scale that considers your levels of ability and your joint's tolerance to movement and load, and it should be meticulously planned with respect to your needs and goals. Finding something generic online or being given some generic handout of things to do might offer a bit of guidance, but if you're seeking to maximize your health prior to your surgery, why not do it all the way?
The joint replacement surgery – What to expect when you're expecting (a new knee or hip)
Every once in a while we encounter someone that looked up a video of what the joint replacement surgery involves (they can be readily found on Youtube), but the majority of people with whom we speak have not seen the surgery and don't have much interest in knowing more.
Having been in the OR for several surgeries and keeping up to date with changes and trends in surgical procedures, we believe that understanding what the surgery entails is important for you as a patient. Consider – if a surgeon does 10+ joint replacements in a week, this is likely to seem so incredibly routine to them. Often, though, for you, this is far from a normal, routine thing. We routinely have people express concerns about the bruising, the generalized soreness in the whole leg (and not just the knee), the swelling, and more. It is important to recognize that, in spite of being a very commonplace surgery, it is still a very involved and invasive procedure. For a procedure that at times can bear more resemblance to heavy mechanical work on a car or construction than a group of humans working on another human, it would be surprising to not come out of surgery with bruising, swelling, and generalized soreness.
Ultimately, though, it's important to recognize that these things generally pass in short order, often within a few weeks, with pain and soreness often continuing to gradually subside over time. We often find that some of the anxiety and fear that can arise from simply not knowing what to expect, what is typical after these types of surgery, leads people to be apprehensive to move and use the new joint. We routinely encounter people expressing concern about nighttime aching, the knee feeling especially stiff after sitting or standing still for an extended period, the skin around the front of the knee remaining numb or "feeling fuzzy" compared to the other side, and more. These are fairly typical things to expect after surgery, and fortunately, at least for a couple of these, there are things you can do in those first few months to try to mitigate those issues and have a more comfortable experience.
Rehab after your joint replacement – Far from "one size fits all"
We've highlighted some of the common symptoms that people often experience immediately after having a joint replacement. Another unfortunate misconception we often find is that people's expectation of surgery is along these lines – I had arthritic change of my knee/hip joint that became painful, it was removed and replaced, and I should be fine. So why do I hurt?
It's important to realize that there is more to a knee or hip joint than just the bones. You have a combination of ligaments, muscles and tendons, connective tissues, and more, as well as the complex nerve tissues that supply these tissues. In what can only be effectively described as an acute trauma, these other tissues may become sensitive as well. Further, the combination of swelling and tissue sensitivity may lead you to being less apt to stretch and move the joint. Commonly, people already face some limitations for mobility going into surgery; layer in the associated effects from surgery, and it's reasonable to expect that the knee joint simply may not move well after surgery. More importantly, this is not something that appears to fully resolve of its own accord, and it requires direct attention in your rehab. The same can be said for strength. Pain is usually the biggest reason people pursue a joint replacement, and if pain prevents you from being active, it only makes sense that strength may become impaired going into surgery. If you weren't able to go up or down the stairs with your affected leg before surgery, we don't routinely see people jump right up after surgery and spontaneously regain this ability. Structured strength training is warranted to make sure that you can get back to doing all of the basic facets of life – getting in and out of the car, getting up and down stairs, getting off a chair, etc. – and getting back to doing the things you enjoy.
Considering all of this, it's important to recognize that everyone is different – different pre-surgical mobility and function, different goals after surgery, different demands and needs. Rehab for a 58-year-old trying to get back to doing HVAC work likely will be dramatically different than rehab for an 80-year-old who simply wants to get back to walking the neighborhood and keeping up with their great-grandchild. Too often it seems that the general perception is that the surgery is routine and that the rehab is as well. In order to maximize your individual outcome and to get back to the specific things you want to do, the combination of manual mobilization of the knee with the exercise prescription to address mobility limitations and strength and function-specific training needs to be unique to you.
If you're planning on having a hip or knee replacement in the near future, we're here for you! Whether it's a simple question or two, looking to see a provider for a couple of visits before surgery to maximize your function and mobility, and/or looking to find a provider that can deliver one-on-one, high-quality care after you've had your joint replacement.