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

[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!