A hip or knee replacement is a surgical procedure where a damaged part of the hip or knee joint is removed and replaced by an artificial part called a prosthesis. People need hip or knee replacements for a variety of reasons including arthritis changes or orthopaedic trauma. Both hip and knee replacements are common procedures with well-rehearsed guidance on the recovery phase.

PROBLEMS ASSOCIATED WITH THIS CONDITION

Due to the nature of joint replacement surgery it is important that the advice provided by the surgical and therapy team looking after you is closely followed. There are several areas that are challenging during the recovery and rehabilitation phase post hip or knee replacement, including:

• Ascending or descending the stairs
• Accessing the bath or shower
• Getting in and out of bed
• Getting on and off the toilet
• Bending to put on socks, shoes or trousers - there are strict rules around this, particularly for hip replacements
• Standing for periods of time to make drinks or meals
• Transporting drinks and meals around the house whilst requiring a walking stick or frame

OCCUPATIONAL THERAPY TREATMENT AVAILABLE

Following a hip or knee replacement your hospital-based occupational therapist is likely to have provided advice and information on how to progress post-discharge. It is important that this advice is followed. An independent occupational therapist can support this in the ways suggested below:

• Ensuring that you have all of the necessary equipment needed for your return home. We often visit clients before they are admitted for surgery to ensure that their equipment package is installed at home and they are fully familiar with its use for when they are discharged. The equipment is likely to include temporary raisers to chairs, beds, trolleys to move items around the home and special stools for use in the kitchen and shower.
• Providing support following discharge to facilitate the rehabilitation process. This may include recommending new techniques for washing or dressing, using the stairs, getting in and out of the car or carrying out daily activities in the safest and most energy-conserving way possible.

PHYSIOTHERAPY TREATMENT AVAILABLE

Physiotherapy before a hip replacement

Before your surgery it is important to stay as active as possible to help with your recovery. Physiotherapy treatment before your operation will involve daily exercises to strengthen the muscles around your hip joint. Walking and swimming are advised in the weeks and months before your surgery to keep your joint flexible and your muscles strong. Your physiotherapist will also provide information and precautions about the surgical process and its outcomes.

Physiotherapy following your hip replacement

Physiotherapy treatment is a crucial part of your recovery, so it is essential that you continue exercises after leaving hospital. Physiotherapy treatment at Physio.co.uk will improve muscle strength and flexibility and help you regain ambulation and function as soon as possible.

Rehabilitation goals will include:

• Decreasing pain and swelling
• Restoring and maintaining full range of motion in the hip
• Increasing strength in the quadriceps hamstrings and glutes
• Re-education of normal gait
• Increasing fitness and endurance
• Promoting independence with functional activities
• Improving quality of life

1-2 weeks

There are certain movements that you should not do in the first six weeks. For example, you shouldn't cross your legs or twist your hip inwards and outwards. Your physiotherapist in hospital will give you further advice and tips to protect your hip.

During the two weeks of your physiotherapy programme, the main aims are to control your pain and swelling, passively improve range of motion and muscle strength. Treatment will also be focused on improving ambulation and how you mobilise around your home. Physiotherapy treatment at this stage will include;

• Initiation of gait training with the use of assistive devices, such as crutches and a walker
• Continuation of functional transfer training
• Progression of ROM and strengthening exercises to the patient's tolerance
• Progression of ambulation on level surfaces and stairs (if applicable) with the least restrictive devices

2-6 Weeks

At this stage of your rehabilitation your physiotherapy programme with Physio.co.uk will continue previous exercises to increase range of movement with the addition of resistance exercises. Exercises will also be functional to increase your independence with everyday activities. Treatment will also include gait re-education (with less assistance) and improving proprioception (balance). Physiotherapy activities will include;

• Strengthening exercises - For example, seated leg extensions, side-lying/standing hip abduction, standing hip extension and hip abduction, knee bends and bridging
• Stretching exercises to increase the flexibility of hip muscles
• Progression of ambulation distance
• Progression of independence with ADLs
• Gait re –education training
• Proprioception and balance training
• Stationary bicycle as tolerated

6-12 weeks

At this point of your rehabilitation your physiotherapist at Physio.co.uk will focus on restoring your functional ability so that you can back to activities you enjoyed previously. Your progress will be carefully monitored to ensure you are safe carrying out your activities. Your physiotherapist will guide and support you throughout your programme to ensure the best possible recovery. Your physiotherapy treatment will consist of a progression of your exercises to build up the muscles in around your hips and in your legs and continue increases range of movement in your hip. Activities to increase your fitness levels may be included such as walking, hydrotherapy and gentle cycling.

12+ weeks

The success of your recovery and the time it takes to get you back to a level you were previously will depend on your dedication to your treatment programme. At this stage of your rehabilitation you will continue to improve with physiotherapy treatment so that you reach your maximum potential. Recovery may take up to 6 months but physiotherapy will improve your quality of life and ability with sporting or daily activities.