By Eileen Beal
Originally Posted On September 16, 2013
If your knee, hip, elbow, shoulder or ankle pain has progressed to the point that it's drastically interfering with daily activities, sleep and work, and you have exhausted all other options, you're probably facing joint replacement surgery.
The key now is to approach the operation with as much knowledge, preparation and confidence as possible.
Joint replacement is a major operation, but it's not emergency surgery. In most cases, you can plan it around your schedule, enabling you to spend the weeks leading up to the procedure doing the crucial physical conditioning, or "pre-hab," that can get you in the best possible condition for surgery and give you the best chance of a quick recovery.
Done properly, pre-hab can shorten your post-op hospital stay. But that's not all: According to a study published in the Journal Arthritis Care and Research, patients who participated in a presurgical exercise intervention reduced their odds of requiring post-surgical discharge to an in-patient rehabilitation facility by 73 percent, regardless of which joint was replaced.
What to Expect From Pre-Hab
Like rehab, pre-hab is an individualized physical conditioning program designed to strengthen and tone muscles, enhance stamina and increase flexibility and range of motion. It's a team effort involving the patient, surgeon and physical therapist aimed at maximizing the benefits and minimizing the challenges that come with a new joint.
While the exercises will likely be similar to those a patient can expect to do in rehab, in pre-hab there's no fear of tearing a surgical wound, wrangling a swollen, painful new joint or dealing with side effects of antibiotics or pain medications, like lethargy, dizziness or constipation.
By training and preparing your muscles in advance for the exercises you'll need to do in rehab, you can make that exercise more efficient and effective. In pre-hab, "you are learning how to do rehab and make the most of it," says Dr. Santiago Toledo, medical director of the Orthopedic Rehabilitation Program at the Rehabilitation Institute of Chicago.
For most people, two to six weeks of pre-hab is enough to prepare for surgery and rehab, although patients with co-existing conditions — like obesity, a sedentary lifestyle, multiple joint problems and cardiovascular disease — will probably require a longer program. "Having co-existing medical conditions doesn't exclude you from pre-hab," Toledo says, "but it limits how much conditioning can be done." (Anyone with high blood pressure or cardiovascular disease should consult his or her doctor before starting pre-hab.)
The best programs are "teaching-learning processes customized to the specific goals and needs of the patient," says Leslie Hoyer, supervisor of outpatient physical therapy at Emory University Hospital in Atlanta. Pre-hab often includes: