Total knee and hip replacements are often advised to those who have severe pain and reduced function, and have been quoted as being some of the most successful operations performed. However, whilst most patients report a positive outcome, some note social isolation due to lack of mobility, and chronic pain. Pre and post-surgical rehabilitation is critical to ensure a high level of success continues with total hip and knee replacements.
There is good evidence to suggest pre-surgical rehabilitation offers better outcomes for function and reduced pain. If work can be done to strengthen and stabilise the joint intended for replacement, then patients will note reduced recovery time, increased confidence and better day-day function.
Post-operatively, home-based exercise or community-based exercise classes may be preferable (patient dependent if they are socially isolated or lonely). Technology to monitor exercise adherence and stimulus intensity during home-based exercise can be useful, such as activity trackers and smartphone apps. A number of patients will happily engage in post-operative rehabilitation, knowing they will experience better outcomes and less pain. However, some will need support and motivation, so rehabilitation should be simple, inexpensive and supervised where possible.
Exercise-based rehabilitation is superior to no or minimal rehabilitation after total hip or knee replacements. However, post-operative rehabilitation programmes should be patient specific, considering socio-economic status, recovery expectations, pre-operative pain levels, psychological status, pre-operative fall rates, and leg muscle strength.