More and more people are undergoing hip or knee replacement surgery to combat the disabling effects of arthritis and improve their quality of life, yet recovery after surgery can be painful and can take as long as one year. But it’s a fact that the fitter you are going into surgery, the faster your recovery time will be.
Growing evidence suggests that just as you would train your body to prepare for a marathon, you can “train” it to prepare for surgery—a concept known as “prehabilitation,” or “prehab.” Granted, you won’t be undergoing grueling physical workouts like a marathon runner, but some light physical therapy and attention to your overall health may contribute to a shorter hospital stay and recovery.
Impact on post-op care
Most people who plan to undergo joint replacement surgery know they will have to undergo rehabilitation after their operation, but prehabilitation can be almost as important. In fact, some orthopedic experts report that participating in prehab may mean the difference between patients’ being discharged to their home or to a rehab facility for inpatient therapy.
That claim is backed up by a review published in 2014 in The Journal of Bone & Joint Surgery, which reported that prehabilitation reduced the need for postoperative care by nearly 30 percent in patients who had a total joint replacement. Researchers analyzed Medicare claims data for 4,733 beneficiaries (average age, 71) who underwent total hip or knee replacement.
Patients who took part in as few as one or two presurgery sessions of physical therapy and learned how to use walking aids, such as canes, crutches and walkers, they’d need after surgery had the best outcomes. They were less likely to be discharged to a nursing home or rehab center or to use home health agency services after surgery than patients who had no prehab. The prehab patients were also trained to plan for recovery and to manage their expectations.
Not only is prehabilitation associated with a shorter recovery time, it improves function and strength, as well. A study in Arthritis & Rheumatism reported that patients who followed a six-week exercise program before hip or knee replacement improved their function and muscle strength and reduced the need for post-op inpatient therapy by 20 percent. By contrast, no improvement in those areas was reported in patients who didn’t exercise before surgery.
The role of exercise
Exercising before surgery to strengthen muscles surrounding the damaged joint is critical. Lack of exercise can cause the muscles to deteriorate and stall postoperative recovery. Not only does exercise tune up muscles around arthritic joints, it can also help retrain movement patterns that allow for a quick return to normal gait patterns after joint replacement surgery.
The best activities are those that limit stress on joints, such as water workouts, stationary bicycling, elliptical machine workouts, brisk walking, bicycling on level terrain and yoga. Isometrics— resistance exercises that require staying in one position for about 10 to 20 seconds with certain muscles contracted and without joint movement—are also a good option. Sitting in a squat position (with knees at a 90-degree angle) with your back against a wall is one example. (Isometric exercises can temporarily raise blood pressure, so don’t do them if you’re hypertensive.) Gaining upper-body strength is important, too; you’ll need it to get around with crutches or a walker.
Talk to your doctor
Working with your doctor to minimize the risks of joint replacement surgery and prepare for recovery is worth the effort. Before surgery, be sure to check with your doctor to see whether an activity is appropriate for you. You can also request a referral to a physical therapist who can tailor a prehab exercise regimen to your needs.
If your doctor gives you instructions for post-surgery exercises, start doing them before surgery. This way you will have mastered the movements before you face the challenge of an incision and a new joint.
Ask your doctor to explain the joint replacement procedure and the type of device being implanted. Also ask what to expect during rehabilitation in terms of pain management, time using crutches or a walker, length of physical therapy, type of home assistance required, time off from work that will be needed, restrictions on activities and time until you can resume full activities.
What else can you do?
Prehab isn’t the only thing that can help boost the chances that you’ll have a successful recovery. Living a healthy lifestyle can help, too. If you’ve been meaning to change any unhealthy habits, now is a great time to do so. Focus on:
• Eating a healthy, nutrient-rich diet that includes calcium and vitamin D.
• Losing excess weight.
• Getting your blood pressure to a healthy level if you have hypertension.
• Achieving better blood sugar control if you have diabetes or prediabetes.
• Quitting smoking.
Last, but not least, don’t overlook your home. Before you head to the hospital, rearrange your living quarters to eliminate fall hazards and give yourself more space. Remove small carpets and obstacles that would get in the way of a walker or crutches, tape down electrical cords and move items that you use often (eyeglasses, medications, phone) so they’re within easy reach.