Pertinent Information on Total Joint Replacements
Grand River Physiotherapy / The Harrington Physiotherapy Clinic is pleased to provide the rehabilitation for both total knee and hip replacement post-surgery for the Cambridge region.
- Print the Patient Exercise Guide for Knee Replacement Surgery and bring to it all your appointments.
Progression of Weight Bearning when Walking
Typically knee prostheses are cemented in place. This means your weight bearing status is “weight bearing as tolerated” and you can progress your gait aids as appropriate. You can progress from a walker to a cane to no gait aid as your tolerance suggests. You should have good active knee straightening (extension) before getting rid of your cane so you feel stable without any aids. If you have an uncemented knee prosthesis then you must use a walker for 4 weeks followed by a cane for another 2 weeks.
If your surgeon has prescribed a Zimmer splint for you to wear at night, then you should wear it for 4 weeks when you go to bed in order to keep your knee straight and improve .
Driving is at the discretion of the surgeon. Generally it is suggested that you not drive for 6 weeks. You must be able to hit the brake hard and be off any narcotics as drugs would impede your reaction time. Return to driving depends on which knee you have had replaced be it left or right and whether you drive a standard or an automatic transmission vehicle.
Range of Motion
The most important aspect of your rehabilitation at the early stages of 0-6 weeks is the effort you put into getting your knee to bend and straighten. Your goal is to achieve 90° of bend by the end of week 2 and 115° to 120° by the end of 4 to 6 weeks. There are some excellent exercises that aim to increase your bending and straightening. The more you do these exercises the more successful you are likely to be. You can also begin to ride a stationary bike with no tension 2 weeks after surgery. You begin riding with the seat higher than normal as a full revolution of the pedals requires less knee bend than if the seat were lower. You do half revolutions at the highest level of a seat position that you can manage. Once you can do a full revolution at this higher seat height you continue to ride at this seat height for 5 minutes after which you lower the seat (as more knee bend is required) and continue this process of half revolutions working up to complete revolutions.
Do not be scared to move around but the first few days but you should also try to ice your knee frequently and “pump” your ankle with your leg elevated. A cryocuff is a device that circulates cool water and ice and this is an alternative to ice. These cryocuffs must be purchased.
- Print the Patient Exercise Guide for Hip Replacement Surgery and bring to it all your appointments.
Progression of Weight Bearing When Walking
Typically hip prostheses are uncemented. This means you cannot put your full weight on your new hip for 6 weeks. Your weight bearing status is “partial weight bearing” for 6 weeks as you have to give time for the bone to grow around the prosthesis which will stabilize the replacement pieces. You need to use two crutches or a walker for at least four weeks post-surgery and then a single crutch or cane for at least two more weeks. If your hip prosthesis is cemented then you can discuss weight bearing progression with your surgeon or physiotherapist.
Movement Restrictions for 3 Months
A total hip replacement requires that the existing hip be exposed by cutting the strong capsule of the hip joint. This capsule helps prevent the hip from dislocating. Surgeons can use a number of approaches to replace the hip. The approach chosen determines which part of the capsule is cut to access the joint. If the back of the capsule is cut which happens in a posterior approach then there is a higher likelihood of a posterior or backward dislocation when you bring your knee toward your chest (flex your hip). If the side of the capsule is cut then there is a higher likelihood of a dislocation with a movement such as crossing your legs. This is why you are not to bring your thigh beyond 90° or cross your legs. It takes about 3 months for the capsule to heal well enough that this is no longer a risk which is why you must not bring your knee up to your chest past 90° or cross your legs for the first 3 months following surgery.
Driving is at the discretion of the surgeon. Generally it is suggested that you not drive for 6 weeks. You must be able to hit the brake hard and be off any narcotics as drugs would impede your reaction time. Return to driving depends on which hip you have had replaced be it left or right and whether you drive a standard or an automatic transmission vehicle.
© 2016 Grand River Physiotherapy, Cambridge, 519 621-3265