Joint Replacement Rehabilitation - Specialists and Information

Rehabilitation refers to the supervised healing and recovery process following the implantation of an artificial joint.

Without rehabilitation, the prosthesis could shift or become loose. Wound-healing complications are also possible.

A joint replacement is a permanent implant that, in the case at hand, replaces a damaged joint.

In addition to the most common applications—total hip, shoulder, and knee replacements—ankle, elbow, and finger joints are also replaced.

The need for these procedures arises in rare cases due to accidents and, more commonly, due to damage resulting from osteoarthritis. The patient population is therefore somewhat older. 

However, modern total joint replacements typically last 20 to 25 years. Therefore, no more than two joint replacement surgeries are required over the course of a lifetime.

Hip TEP surgery replaces the hip socket and the femoral head @ SciePro | AdobeStock

Rehabilitation after joint replacement has three main goals:

1. Patients learn the correct movement patterns with the artificial joint.
2. Supervised rehabilitation reduces the risk of complications
3. Joint replacement rehabilitation promotes targeted muscle strengthening

Point 3 is important because patients have not been able to move the damaged joint properly for quite some time prior to surgery. In general, orthopedic rehabilitation is just as important to the success of treatment as the surgery itself.

Generally speaking, yes. There may be younger patients who carry out the rehabilitation program independently at home under outpatient supervision, but these are exceptions. Health insurance companies cover the costs of rehabilitation.

The procedures differ depending on whether rehabilitation follows the implantation of a prosthesis for:

• Knee
• hip, or
• shoulder

Generally, rehabilitation takes two to three weeks, though it may take longer depending on the type of prosthesis, age, and physical condition.

Postoperative rehabilitation following knee replacement has a decisive impact on the prosthesis’s lifespan.

For this reason, joint replacement rehabilitation begins on the very first day after surgery.

It pursues the following primary goals:

• primary wound healing
• Reduction of swelling
• Pain management
• Achieving a good range of motion

The first steps involve contracting the muscles around the knee and early gait training. This is followed by exercises for strength, endurance, flexibility, and coordination.

At the same time, medical monitoring is performed using surface EMG. This is a form of electromyography that is conducted while the knee is in motion.

Doctors also monitor gait and the proper functioning of the knee. An essential part of total knee replacement rehabilitation is motivating patients to perform exercise routines for the rest of their lives. This enables younger individuals to return to sports.

A total knee replacement (TKR) is an artificial knee joint that completely replaces the natural joint @ Henrie /AdobeStock

Rehabilitation following hip replacement surgery may take longer. It is important to note that patients are typically at least 70 or 80+ years old. Therefore, wound healing of the upper muscle and skin layers usually takes 14 days, while internal healing takes about three to six months.

Rehabilitation following joint replacement reduces pain and restores the necessary mobility and strength to the hip. For younger patients, it also allows them to resume athletic activities.

Rehabilitation lasts at least three weeks, though the desired final outcome is not yet expected at that point. However, patients are generally able to move around pain-free after this period.

The goals of hip replacement rehabilitation following hip surgery are:

1. Restoring normal movement patterns when walking
2. Normal use of the restroom
3. Reducing pain when sitting and lying down in all positions

This requires specific exercise routines supervised by an orthopedic physical therapist. The patient must not put excessive strain on the new hip immediately after surgery. 

Training to adopt the correct sleeping position is also important: Ideally, patients should sleep on their backs for three months after surgery, but for at least 14 days. When sleeping on their side, the operated side must be on top and should be supported by a pillow.

After hip surgery, patients must learn that they should:

• not sit in a low position
• not cross their legs
• not twist their upper body while their legs are stationary, and 
• not use stairs without holding onto the handrail

Physical therapy mobilization of the shoulder joint following shoulder replacement surgery begins immediately after the operation. It is performed through passive physical therapy.

The physical therapist moves the patient’s arm. The type of movement is precisely prescribed. A shoulder motorized splint may also be used. On this device, the operated shoulder joint moves within a pre-set range of motion.

The following are trained:

• Muscle strengthening
• Coordination
• Mobility

Patients learn to perform the necessary movements on their own. To this end, the physical therapist trains them using active physical therapy exercises.

Physical Therapy Following Shoulder Total Joint Replacement @ contrastwerkstatt /AdobeStock

It is crucial for patients to apply appropriate weight-bearing to the artificial joint and avoid improper movements. 

This primarily refers to extreme movements. When walking after knee or hip replacement surgery, forearm crutches are still required for some time. 

Carrying heavy loads should generally be avoided. Loads exceeding 20% of one’s own body weight are considered heavy. It is also advisable to use antibiotics to protect against infections.

Possible complications include:

• Thrombosis
• Infections
• Loosening of the prosthesis, as well as
• Injuries to muscles, skin, or bones

These risks can be minimized through properly conducted prosthetic rehabilitation. The prognosis for a successful recovery naturally varies from case to case, but is generally good.

There are now well-established procedures for joint replacement. The materials used in artificial joints have also continued to improve. A well-managed joint replacement rehabilitation program significantly increases the chances of success.