Total Joint Replacement

Knee replacement model

Many people undergo joint replacement because of pain or an inability to perform activities they previously enjoyed. Although joint replacement plays a big role in alleviating pain and helping patients/clients return to their fav
orite activities, it is only one step in a long journey. After joint replacement surgery, physical therapy plays a critical role in recovery and can determine the success or failure of the surgery’s ability to relieve pain and restore function.Knee replacement model

As you know, the goal of this surgery is to remove and replace the diseased bone located along the joint surfaces, which contribute to pain with joint movement. However, there are many other factors that need to be considered
and addressed when this surgery is performed. First, although overall, many people experience less pain post-operatively, we must consider surgery a trauma in itself and pain should be expected. In fact, post-surgically, patients will experience characteristics of the inflammatory process, a normal part of healing, which include pain, heat, swelling, redness, and loss of function. Physical therapy can play an important role in addressing the components of inflammation and the healing process.

As important as addressing the components of normal tissue healing is a physical therapist’s role in determining what is part of the normal healing progression and recovery and what may be a post-surgical complication. Although complications after joint replacement are not very common, some require immediate medical attention and your physical therapist is trained to recognize when these situations arise. Early recognition in the case of infection, for example, can lead to prompt treatment and not result in a delay in recovery process, or the need for further surgery.

A second significant factor to consider after joint replacement surgery is, surgery does not address any of the soft tissue limitations that may have contributed to bone wear and tear. It also does not address any soft tissue restrictions that may have developed as a result of joint movement avoidance due to pain. Many times, in the absence of an obvious trauma, knee osteoarthritis (wear and tear) does not have an identifiable cause. Wear and tear of the knee or other joint may occur because of abnormal soft tissue mobility in the region surrounding the joint or in adjacent and even distant regions of the body. For example, limited mobility in the hip and pelvis may cause excessive stress and abnormal mechanics in the knee. Joint replacement surgery will not correct this and if left unaddressed this dysfunction can result in wear and tear in other joints throughout the body and even shorten the life of your joint replacement.

Additionally, osteoarthritis or wear and tear in the joint may have resulted in the avoidance of certain movements. For example, pain in the knee may cause someone to avoid fully extending (straightening) his or her knee while walking, which is an important part of walking. Over time, the soft tissue around the knee including muscles, tendons, and fascia, may become tight and contracted. In this situation, even after the joint is replaced, limitations in tissue flexibility may persist and prevent a person from fully straightening their knee, which could cause further gait alteration and continued pain.

When considering joint replacement, it’s important to note that even though the diseased bone will be replaced with new joint surfaces after surgery, this is one step in a long process. Many times, following surgery, patients will require weeks to months of physical therapy in order to fully regain function of that joint. Treatment will use a multifaceted approach including: addressing range of motion deficits, restoring strength, correcting soft tissue mobility limitations, and retraining normal gait mechanics. All of these components are essential to ensure patients/clients are able to perform activities of daily living correctly and without pain.

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