Prehabilitation and Rehabilitation for Knee and Hip Replacements
Written by: Alister
Published on: March 31, 2021

Preparation for your recovery from a joint replacement begins before your surgery.

If you are considering a joint replacement or have been told that you will need one, pre-habilitation or “prehab” involves exercise training prior to having surgery.

The prehab training will consist of resistance training and exercises to help with improving daily activities such as walking, stair climbing and squatting tasks.

The overall aim of prehab is to enhance your physical function to improve your post-operative outcomes. Prehab has been shown to improve pain and function, whilst decreasing length of stay in the hospital following surgery1,2.

Improving your preoperative physical function will better prepare you for the next stage of treatment after surgery. Whilst the physical benefits of completing prehab are important, so too are the mental health benefits.

Waiting for a joint replacement surgery can be quite stressful, causing anxiety and worry about the outcome of the operation. Regular exercise (within your capabilities) may help to ease any anxiety, improve your mood, and increasing self-confidence to return to an active lifestyle post-surgery.

Below are some examples of exercises that you can start completing at home before surgery. Because everyone responds to exercise differently, you need to be the judge of how much exercise you can do each day.

If an exercise causes an increase in discomfort, stop doing that exercise. Seek advice from an exercise professional if you are unsure about these exercises.

Work up to doing 10 to 20 repetitions of each exercise multiple times.

1. Bridging

  • Lying on your back with knees bent.
  • Squeeze your buttocks together and lift your bottom off the floor. Return to starting position.
  • Repeat 10 times.

2. Quad Extension Over Pillow

  • Bend one leg and put your foot on the bed and put a cushion under the other knee.
  • Straighten your leg by pulling your foot and toes up, tightening your thigh muscle (keep knee on the cushion).
  • Hold for approx. 5 secondsand then slowly relax.
  • Repeat 10 times.

3. Wall Sits

  • Stand leaning with your back against a wall and your feet about 20cm from the wall.
  • Slowly slide down the wall until your hips and knees are at right angles. Return to starting position.
  • Repeat 10 times.

3. Standing Hip Extension

  • Stand straight holding onto a chair for support.
  • Lift one leg back keeping the knee straight. Do not lean forwards.
  • Repeat 10 times.

Rehabilitation and why is it important for joint replacements

After you’ve had your joint replaced, the next phase of treatment will involve post-operative exercise rehabilitation both in the hospital and to complete at home.

The aims of rehabilitation after a joint replacement surgery is to address the functional needs of everyday life (e.g. walking, getting to and from the toilet) and to improve mobility, strength, flexibility and reduce pain.

This starts off as an assisted process, but the aim is to get the individual as functional as possible prior to discharge from hospital .

As a result of a degenerated knee or hip joint, the muscles surrounding the joint can reduce in size and become weak.

The surgery helps to correct the joint problem, but the weakened muscles will remain a problem unless there is ongoing rehabilitation to restore their function.

After being discharged from hospital its important to continue with a targeted strength program, which over time can help to achieve significant improvements in day-to-day activities.

Daily life requires a lot of walking and squatting tasks. If you can create a solid plan to increase your total tolerable walking distance each week and squatting capabilities, you’re going to do really well.

However, there may be other individual tasks that you’re struggling with which can be further discussed with your exercise professional.

As previously mentioned, the rehabilitation process after having a total joint replacement isn’t only about the physical aspects.

It’s also about building confidence and self-efficacy, reducing stress and anxiety, and overcoming the fears and challenges that come along with having a total joint replacement.

REFERENCES:

1. Moyer R, Ikert K, Long K, Marsh J. The Value of Preoperative Exercise and Education for Patients Undergoing Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev. 2017;5(12):JBJS Rev. 2017;5(12):e2.

2. Jaggers JR, Simpson CD, Frost KL, Quesada PM, Topp RV, Swank AM, Nyland JA. Prehabilitation before knee arthroplasty increases postsurgical function: a case study. J Strength Cond Res. 2007 May;21(2):632-4. doi: 10.1519/R-19465.1. PMID: 17530958.

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