The Importance of Exercise After Joint Replacement Surgery
Joint replacement surgeries, such as knee replacements and hip replacements, are common in those with end stage arthritis and can sometimes can also occur when younger from certain musculoskeletal conditions and/or significant injury.
The American Academy of Orthopaedic Surgeons (AAOS) explains that total joint replacements are usually recommended after non-surgical treatments such as medication, physical therapy and lifestyle changes do not relieve pain symptoms or limited function as a result of one’s condition.
They go on to describe how joint pain that may lead to surgery can, in many cases, come from damage or wearing away of the cartilage that lines the ends of the bones. The lack of cartilage can lead to bone impacting on bone, causing pain inside the joint.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) also describe how the purpose of joint replacements are to remove parts of joints that are damaged or diseased and replace them with artificial parts in order to allow for improved movement and stability of the joint and therefore better day to day function.
What’s also important to note, in addition, is that a joint replacement surgery in and of itself will not entirely fix the symptoms in every case.
The reason being is that whilst joints are replaced, the surrounding structures i.e the muscles, ligaments, tendons and other soft tissue structures, need to also adapt and strengthen to be able to support the newly replaced joint.
Especially after a significant surgery such as this, it is always recommended to limit physically strenuous activity in order to prevent any negative side effects. Whilst this is advisable and entirely correct, it’s worth understanding how this impacts long term function, also.
This lack of activity reduces the muscle strength around the new joint and unless addressed can lead to a downward spiral where lack of strength leads to less activity, and less activity leads to increased lack of strength.
For example, the Journal of Bone and Joint Surgery published a study in 2005 showing that quadriceps (front area of the thigh) strength reduced by 62% following a total knee arthroplasty (replacement). This is a significant loss of strength but is quite expected, given the nature of the surgery.
The key is to be aware of this, so that if you are to have a surgery in the future you know the importance of strengthening the muscles after surgery (as approved by your medical progressional).
As a physiotherapist in Crawley I always stress to my patients that it’s important to remember bones move because muscles tell them to. Bones cannot move without the instruction of the muscle, which in tern is controlled by nerves from the brain. With improper muscular function, bones and joints lose their function.
Arthritis Research UK, a leading research organisation based here in England also noted on the importance of exercise after joint replacement. For example, when educating the public about care after knee replacement surgery, it noted the fact that exercises can be painful at first, given the adaptation the body has to undergo for the new joint, but as your strength improves and the healing of the joint completes, you’ll be able to see more functionality develop in the joint.
This is important to know, because the slight discomfort you may feel when trying to do gentle exercises after surgery may make you want to reduce the frequency or intensity of the program from what was prescribed by your medical professional. The key is to remember that with lack of use, muscles get weaker, and this will eventually make the joint less mobile and functional.
It goes without saying, any exercise programme or routine should always be confirmed first by your doctor.
It doesn’t just affect the knee, the case of muscle weakness results from any joint replacement surgery. The Public Library of Science in 2013 assessed the strength of 35 patients undergoing total hip arthroplasty.
The study found that hip muscle strength and leg press power was reduced from anywhere between 41% and 58% after day 2 and by day 8 anywhere between 23% and 31%. Therefore the need for safe exercise is essential when rehabilitated any joint that has undergone replacement.
In terms of which exercises to do, this will entirely be on the advice of your surgeon or appropriate medical practitioner.
As a guideline of what you may expect when having your exercise programme prescribed, the following organisations have released exercise sheets for your consideration:
The American Academy of Orthopaedic Surgeons: Total Hip Replacement Exercise Guide
Allina Health: Knee Replacement Home Exercise Program
Oxford University Hospital: Shoulder Replacement Information Guide (Exercise Sheet on Page 16)
Beacon Hospital: Total Ankle Replacement Guidelines and Exercise Program
Oxford University Hospital: Elbow Replacement Information Guide (Exercise Sheet on Page 13)
Sussex Hand Surgery: Total Wrist Replacement Exercise Program
Physiotherapist BSc MCSP HPC
Founder and Principal Physiotherapist at Tavistock Clinic.
HCPC Registration Number PH97986
CSP Registration Number 089576