Preoperative care before major joint replacement: What do you do?

[Ontogenese]

Dear all,

I was wondering what your opinions are about preoperative care before a total hip or knee replacement. At this moment I am working on some articles describing the preoperative period and possible interventions during the waiting period.

I am interested in what you people think about preoperative care by physiotherapists in an ortopedic setting.

Do you think it is necessary or useless?
And what care do think would be relevant?

I am looking forward to hearing from you all.

Kind regards,

Thomas

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[Judith Mollet]

Dear all,
I was wondering what your opinions are about preoperative care before a total hip or knee replacement. At this moment I am working on some articles describing the preoperative period and possible interventions during the waiting period.
I am interested in what you people think about preoperative care by physiotherapists in an ortopedic setting.
Do you think it is necessary or useless?
And what care do think would be relevant?

I am looking forward to hearing from you all.

Kind regards,
Thomas

Excuse the stupid question but what do you mean by "orthopädic setting"?
Are you referring to the outpatient situation and appointments they have in the weeks or days pre-op or in the hospital the day before the OP?
Immediately pre op I've seen excellent information brochures in hospital (near me)that the patient should have given to them and also explained if neccesary. The ability to comprehend what is about to happen before and straight after OP is sometimes impaired even in the most sensible intelligent clients. The risks etc of OP are normally explained by surgeon/others doctors. Too much info will result in it being forgotten often!
If you mean physio hands on stuff/ treatment then I would not do anything. Maybe check on suitable shoes, walking aids etc, and if time the amount of disability in ROM / muscle weakness existing. They have probably had an amount of outpatient physio over months or years prior to the operation which hasn't helped enough in the end as the joint/soft tissue pathologie hip/knee is too severe.
The "waiting period" you mention is probably very variable depending on the country in question. Here in Switzerland it's relatively short. I've treated hips, as long as it's giving some relief, on an outpatient basis until the OP date is known, then said goodbye till after the inpatient stage. Treatment would depend on what still helps. Some hips are very stiff with less pain, some stiff with severe pain. Some have associated back problems due to hip contractures and bad posture etc over 2-3 years.....Some hips have already crumbled pre-op so I think recomendations as to whether necessary, useless or what to do should be on an individual basis.
Has what I said given you some answers? Do you want interventions to be more specific?

[IceMan]

I would think that strengthening and mobility activities prior to joint replacement surgery would be beneficial. Assuming that you would expect to see diminished strength and ROM in the affected lower limb post surgery, it would make sense that the more you have prior to surgery the better off you'd be after surgery.

[Josephine]

I can attest to that, IceMan. I had a knee replacement 9 weeks ago. Knowing it was in the offing, most of last year I visited my local gym and used a good range of equipment but nothing too intensive. I think towards the end I was using 10 different machines and feeling heaps better. For the record I am 67 and was the template for the couch potato!!

Anyway, come early December I can no longer do the gym stuff. So knee was done in March. I cannot believe the speed of my recovery! I was at 90 degrees of flexion before the week was out! It was 130 degrees, was walking without any aids plus going up and down stairs normally by the end of week 3! Now it's 135 and sometimes more.

I put it all down to the gym work I did last year. I just started back at the gym early this week.

Hope that helps your project.

[Judith Mollet]

Well done Josephine, sounds as if it went well. Here in Switzerland with the knees I've seen you wouldn't be allowed to go down stairs normally so soon. The aim is 90° flexion before going home, increasing to 110° /120° afterwards. Depending in the state of muscles and proprioception getting rid of elbow crutches at 4-6 weeks post op. The beginning of closed chain weightbearing exercises in flexion (in standing) is after the 6 week check up and then starting only to 40°, first with both legs then later on to single leg flexion. This is due to the tuberositas tibiae being removed then screwed on again. Sport is advised after the 4 month check up. I?m sure there are differences due to type of Knee, surgeons skills etc etc, you know more about it having worked in OP I'm sure.
What did you do between december and march ? Although you say you are a couch potato you are certainly not an average one because of your previous working life. A head start in information like we have is not the same as the general public. Did you have physio pre-op? The point I was making has to do with the fact that it's difficult to improve something that has got so far that a replacement has to take place. Pain inhibition, secondary inflammation due to cartilage destruction etc etc will often make it impossible even to maintain strength and mobility at some stage pre-op. If physio interventions on outpatient basis can help somewhat in the downwards spiral of function leading up to the OP date OK, keep on. Otherwise it can be rather a waste of time and resources. Some bright patients will have learnt enough about exercising to be able to continue some sort of home exercise-programm themselves when, for example gym work is no longer possible. Others may need supervision to avoid even worse contractures before the OP
Ontogenese said:
"I am interested in what you people think about preoperative care by physiotherapists in an ortopedic setting"
Where are you Ontogenese??
Good luck in the gym Josephine. My mother in law got back to riding the bike (outside)after bilateral knees at over 75!