While choosing the right orthopaedic surgeon is important when it comes to hip or knee replacements, many patients do not realise that they, too, play an important role in the outcome of surgery.
What are prehab and rehab?
Being committed to your own recovery can help you get better faster and can make a difference to how well your new hip or knee performs. Many people are familiar with the idea of rehabilitation – a programme of exercises after surgery to build strength and prevent stiffness – but prior to surgery, exercises can also be beneficial. We refer to this as prehabilitation.
The benefits of prehab
Prehabilitation helps build strength and flexibility, which can be invaluable in the days and weeks after surgery. After a knee replacement or hip replacement, your surgical team will encourage you to get out of bed and walk to the bathroom within 24 hours. Before you can be discharged, they will want to make sure you can climb a few steps and walk a short distance. You’ll need to be able to get in and out of the car when you are discharged and also get into bed at home.
Building up your fitness in the six weeks before surgery will help you reach these milestones faster. Prehabilitation may reduce the amount of post-operative pain you experience and it can also lower the risk of developing complications. Having completed an exercise programme prior to your hip or knee replacement is likely to make it easier to get to grips with the post-operative rehabilitation programme recommended by a physiotherapist.
In addition to exercising, eating a nutritious diet and achieving a healthy body weight is another key component of prehabilitation. Not only will it help you feel better, but if you are carrying excess pounds, losing weight can help to relieve pressure on damaged joints.
Prehab exercises prior to hip replacement
Among the exercises that may be suggested prior to a hip replacement are:
- Lying on your back. Bending your knee and sliding your foot towards your bottom using a plastic back to help it move smoothly. Hold for five seconds before extending your leg so it is completely straight. Repeat 10 times.
- Also lying on your back, this time with both knees bent, lower the affected leg slowly to the side and then bring it back up to the starting position. Repeat 10 times.
- Stand facing a wall with both hands on the wall for support, elbows bent. Still facing the wall, move one leg backwards as if you were going to step back. Return to your starting position. Repeat 10 times.
- To improve balance, stand up, holding onto a fixed support in front of you. Tighten your bottom and thigh muscles and transfer your weight onto your non-affected leg, lifting the other leg off the floor. Try to maintain your balance for 30 seconds. Put your foot down and do the same on your other leg.
Tips for prehabilitation exercises
Low impact exercise like walking or swimming are ideal prehabilitation activities. Alternatively, a physiotherapist can recommend a tailored exercise programme to increase your strength and range of movement, as well as improving your balance and aerobic capacity. The secret with exercising is to start slowly and build up gradually. Mild aches and pains in the muscles are fine but they should ease off once you stop the activity. Never force yourself to push through pain. If you do experience joint pain the following day, reduce the amount of exercise and build up more slowly.
Rehab after surgery
After surgery, it is important to follow the rehabilitation plan recommended by your surgical team. Immediately after your operation you will be supported to get out of bed and start walking with the aid of crutches or a walking frame. Before you leave hospital, a physiotherapist will recommend a daily exercise programme to support your recovery. It is important to do these regularly as they will help to build strength and suppleness. You should get up and walk for around five minutes every hour to prevent blood clots. For the first six weeks or so you will need to use an aid to help you walk. As you feel more confident, you can drop down to one crutch and then a walking stick before starting to walk unaided when you are ready.
Around six weeks after your operation you will have a follow-up appointment to check you are recovering well. In the meantime, if you notice any unusual swelling, worsening pain or discharge from the wound, contact your surgeon. You will normally be able to return to work around six to 12 weeks after surgery, depending on the type of work you do.
Contact us for more information about prehabilitation and rehabilitation to support the best outcomes following a hip or knee replacement.
