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Preparing yourself for surgery is an important step that can be fraught with anxiety and uncertainties.
As soon as you decide on elective surgery, such as a total joint replacement, it would be best to start preparing for the big day to ensure a successful rehabilitation.
Total joint replacement surgery is very common, and the procedure has been streamlined considerably since the early days of joint replacement. In fact, total joint replacement is one of the most commonly performed and successful operations in orthopedics! There are several ways you can ensure a successful recovery from total joint replacement.
Prehabilitation: There is conflicting evidence on the effectiveness of prehab or physical therapy before surgery. The theory here is “stronger in, stronger out,” and although some anecdotal evidence supports this, some larger studies are inconclusive(1). One small randomized trial concluded that participation in online prehabilitation exercises could predict patient engagement and correlated to decreased length of hospital stay and decreased use of assistive devices at 90 days. (2) However, the jury is still out, and there are more studies underway. Since you will be reliant on your upper extremities to get out of bed and out of a chair, strength training is recommended to improve your arm and core strength to prepare them for the extra workload. Since you’ll be working out the top half of your body, you might as well throw in a couple of leg exercises for good measure!
Home prep: You will need to use an assistive device after surgery for a while, so you should prepare your home space to accommodate this by picking up throw rugs, clear entryways, and common living areas and move away trip hazards such as loose cords. Some very useful equipment for after surgery are shower chairs, raised toilet seats, long-handled shoehorns, and sock aids. Retaining independence and being safe to shower and dress is helpful for any recovery, and these items can make those tasks more manageable.
Mental prep: Recovery is going to be different for everyone, but there will be some common themes. There will be pain. Surgery is traumatic to the body and surrounding tissues. You will be tired and have painful swelling. This is normal and to be expected. The first two weeks will be most challenging, but you should start to notice an improvement by the end of 2-3 weeks. Be sure to communicate regularly with your doctor, PA, nurse, and physical therapist regarding your recovery. Understand that it will be months before all these issues are completely resolved, and recovery is much like a roller coaster. Some days will be good and others not so much. However, by the 5-6th month post-recovery, you should be ready to tackle your old activities with new zest and maybe feel ready to engage in some new ones!
Questions to ponder: It is important to discuss your concerns with your doctor, PA, or nurse prior to therapy. Here are a few pertinent questions to ask:
1: Will I get a custom fit prosthesis or implant?
2: Will I have robotic-assisted surgery?
3: What physical restrictions will I have post-op?
4: What is your pain management protocol?
5: Will you order a cryotherapy machine for home use? (Note: most insurances do not pay for this, but it is so helpful, especially for knees)
6: Am I a candidate for outpatient surgery? If not, how long will I be hospitalized?
7: What type of sutures will be used?
8: What is the home care protocol?
9: When can I start Physical Therapy?
10: When can I drive?
All this may be a bit daunting, but the majority of folks who underwent these procedures wondered why they waited so long. Your new joint will open up new possibilities for a more active, enjoyable, and pain-free lifestyle.
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References:
1: Franz A, Becker J, Behringer M, et al. Skeletal Muscle Health in Osteoarthritis and Total Joint Replacement Therapy: Effects of Prehabilitation on Muscular Rehabilitation. German Journal of Sports Medicine / Deutsche Zeitschrift fur Sportmedizin. 2019;70(6):145-152. Accessed August 12, 2021.
2: Denduluri SK, Huddleston JI 3rd, Amanatullah DF. Preoperative Exercise Participation Reflects Patient Engagement and Predicts Earlier Patient Discharge and Less Gait Aid Dependence After Total Joint Arthroplasty. Orthopedics. 2020;43(5):e364-e368. doi:10.3928/01477447-20200619-04
