Joint Replacement: Everything You Need To Know
- Vitality Fitness and Rehab
- Nov 27, 2023
- 4 min read
Updated: Nov 28, 2023
Joint replacement is a surgical procedure that is carried out to replace all or part of a diseased joint with an artificial replacement. The most commonly replaced joints are the hips and knees.
A total hip replacement means the entire joint is replaced, whereas a partial hip replacement means that only a part of the joint is replaced.
Osteoarthritis (OA) is the most common reason for knee joint replacement.
Approximately 72,000 hip procedures were recorded in the National Joint Registry in 2007.
Common Causes/Risk Factors
Joint replacements can be necessary as a result of the following:
Chronic obesity (some NHS Trusts restrict access to the procedure for obese patients)
Effects of being overweight
Wear and tear. Some professions have a higher rate of arthritis and with that, a higher likelihood of joint replacements. These jobs include manual work such as electricians and it is mainly impacts the knees.
Osteoarthritis
Partial joint replacements are also a possible cause for a full replacement.
Post Surgery: Joint Replacement
The new joint will be unstable and prone to dislocation for a few weeks after the operation.
Rehabilitation will be required post-surgery.
Normal functioning should be possible after six months.
Lifespan of a joint replacement is around ten years.
The patient will receive strict instructions and guidelines to follow during the period of recovery which is usually three months. Assuming that there are no complications, the patient is expected to be back to normal, with a new lease of life, after six months.
Treatment and management
Physiotherapy - Immediately after the operation, the patient is likely to undergo a period of rehabilitation led by a physiotherapist. In some parts of the UK, a period of 'pre-hab' is also offered to condition the muscles around a joint before surgery. Pre-hab would include a comprehensive programme that targets muscle surrounding the affected joint pre-surgery. This has been shown to improve recovery time and outcome of the surgery.
Physical activity - The patient should be encouraged to engage in regular, gentle exercise to strengthen the muscles around the joint, improve stability and maintain mobility. Such exercise will also manage body weight which will have an effect on weight-bearing joints.
Benefits of exercise
The benefits of exercise for individuals prior to a joint replacement include:
Improved ability to carry out ADL
Improved strength and mobility around affected joints
Maintenance of stability around affected joints
Reduced risk of coronary heart disease
Maintenance of functional movement.
The ACSM makes no specific recommendations for exercise after a joint replacement. Instead, it is suggested that the guidelines for apparently healthy individuals are used. It is our recommendation that you seek professional guidance in a person or team that is able to support you through the months leading up to surgery and the subsequent months after.
Exercise programming and Considerations
*Remember, these programming tips and considerations are generic and it is important you speak with your doctor before implementing anything into your exercise routine.
Include exercises for all actions at affected joints.
Gradually increase range of motion and resistance.
Promote flexibility and mobility.
Strengthen muscles that support affected joints.
Exercise in deep water however it is recommended to speak with your doctor because exercising in deep water can be a contraindication of other forms of health conditions.
Considerations
Side effects of medication.
Level of pain experienced.
Some exercise positions may be uncomfortable (such as kneeling).
Limited abduction initially (hip replacement).
Consider support options early on in the rehab and slowly reduce reliance.
Avoid hip flexion past 90 degrees (for hip replacement).
Risk of dislocations.
Avoid adduction past the midline (for hip replacement).
Avoid swiveling or pivoting.
Avoid breaststroke when swimming.
Exercise programming
Stair-climbing is a good exercise and relates very well to ADLs. After a hip replacement, we encourage those to climb stairs, leading up with the good leg and down with the leg that has undergone the operation.
Given the life of a new joint is only approximately ten years, it is important to take into account the consideration and cautions listed to make sure that the maximum use is obtained.
When working in the gym environment, a careful examination of the equipment available is necessary to ensure that the guidelines given are properly followed. Sometimes the action of the machine itself is appropriate but access to and from the machine (getting on or off) can present risks that should be avoided. For example, some recumbent bikes require a lot of hip flexion to step into them (more than 90 degrees), and some treadmills have a big step up from the floor. In both cases, moving a step into position to reduce the angle at the hip may be sufficient to reduce the risks outlined.
The floor is an excellent place for people to perform exercises that are best suited post-surgery. Being in a supported and stable position and being able to work against gravity can have significant benefits.
In Conclusion
Joint replacements have high success rates and can give the patient a new lease of life however it is a serious operation and should be treated like so. We often see people who have their replacement get to a point where they feel pain free day to day or are able to carry out their dailty tasks and they then proceed to stop all rehabillitation. This is not recommended as although you may be fine performing tasks inside of your daily activities, this does not mean that you are protected with strength and stability that could protect you from further injury down the line.
Live, move and feel better, for longer.
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