Post-Surgery

Rehabilitation usually begins the day after surgery, although if your surgery is early in the morning, the staff may want you to try getting into a chair later that day. Everyone responds differently to anesthesia and surgery, but if you have no complications, it is best to get up and moving as soon as possible, even though you may not feel like it. Getting up significantly decreases the risk of blood clots (which is a normal post-surgical risk) and helps your bodily systems return to normal.

Please do not try to get up on your own or with a spouse s aid, unless your spouse knows how to transfer patients. Your therapist will tell you how much weight you can put on your surgical leg and will supervise your rehabilitation program while you are in the hospital. During this time you will usually walk with a walker (several times per day) and do exercises for your surgical leg.

The most common knee exercises include quadriceps sets, straight leg raises, short-arc knee extensions, and range of motion exercises. Following hip replacement, exercise is often focused on hip extension and abduction. The purpose of this program is to get the muscles firing again, since pain inhibits muscle contraction, and to start regaining range of motion. You may think that these goals sound quite easy —you can lift your leg off the ground now, and surely you can do so after the surgery. My father was quite surprised the first day after surgery, when he tried to do his exercises. What had been exceedingly easy two days before was not possible, and he needed help to get his leg off the bed. This weakness is typical, because the nervous system protects the injured site. With repetition of the intended action, normal function slowly returns.

Before going home, make sure you know what exercises to do at home, how much weight you can put on your surgical leg, and what activities you must not yet attempt. The home exercise program is usually similar to the regimen you started while in the hospital, but now you are responsible. I suggest setting a schedule, which will help you adhere to the program. A simple way to keep track of your regimen is to use a calendar and draw three boxes (representing three exercise sessions) on each day. As you complete each session, you can check that box and thus reinforce your regular schedule.

I also recommend doing a few exercises while standing with your walker or leaning against the kitchen counter. Such exercises include hip extension and abduction for both legs. The leg muscles can become tight when you are sitting a lot during your recovery period. Since the hip muscles are central to walking, you need to maintain their range and, if possible, their strength.

Many programs focus on knee flexion, but it is also essential to get knee extension back to normal range. The quadriceps set exercise works on knee extension, and a small rolled-up towel placed under your knee can give you tactile feedback when you are pushing the back of your knee into it properly. You can also use gravity to help develop knee extension. While you are sitting, place you heel on a low stool or coffee table, with nothing under your knee. Try this position for a few minutes at a time. It is not comfortable, and I find that most people feel better when they do some repeated knee flexion afterward to loosen up the knee. In fact, your surgical knee stiffens rather quickly, so do a few extension and flexion movements periodically, or get up and walk every hour or so.

When the hospital discharges you to go home, they should give you a referral for physical therapy. Therapy can take place either at home or in an outpatient facility, depending on where you live and what your insurance covers. If your doctor has mentioned therapy, make sure to ask about it before your discharge.

One aspect of fitness that people often neglect during the initial recovery period is cardiovascular fitness. Start with short walks, using your assistive device, usually in the house. Most people focus on functional activity —they walk from one room to another to get something. Try to increase the duration either by walking in place for five minutes, if you can put weight on your leg, or by walking the length of the house several times.

Until you can start walking for longer periods, be creative about doing some aerobic activity. If your doctor allows it, you can use a stationary bike (the seat will need to be adjusted for your surgical knee). If you do not have a stationary bike, you can use your arms to get some aerobic exercise. Holding your arms just below shoulder level, pretend you are pedaling with them. As you have probably not used your arms for aerobic exercise before, you will find that you cannot keep it up for long. If you do it several times a day, however, you will gain some aerobic benefits and can probably work up to five minutes per session. As with any exercise, this movement should not cause pain in your shoulders. Once you start walking more easily, gradually increase the time or distance that you walk.