Protocols.
Written, procedure-specific rehabilitation protocols are available for every operation performed in this practice. Call the rooms on (07) 5493 8038 or email reception@scorthogroup.com.au and they will be sent through. If a patient names your practice, the protocol is sent to you directly at the time of surgery.
Before surgery.
Pre-operative strengthening is worth the effort and the evidence is better for the knee than for the hip. Quadriceps strength before a total knee replacement predicts function after it, and it is far easier to build before the operation than in the six weeks afterwards. Where a patient has a date and is not yet in a programme, that is a reasonable reason to start one.
Teaching crutch technique, stairs and transfers pre-operatively also shortens the inpatient stay, and it removes the problem of learning a new skill on day one with a nerve block and an opioid on board.
Hip replacement, anterior approach.
- Full weight bearing from day one unless specified otherwise.
- No routine posterior hip precautions. The posterior structures are not divided. Patients are frequently told otherwise by well-meaning third parties and it slows them down.
- Avoid aggressive hip flexor stretching in the first six weeks. The interval is anterior and the rectus and iliopsoas have been retracted.
- Priority is normalising gait rather than loading early. Aids come away in the order two crutches, one, none, driven by gait quality. Discharging aids before the gait has normalised trains a Trendelenburg pattern that then has to be unlearned.
- Abductor strengthening, then balance and endurance from about six weeks.
- Lateral femoral cutaneous nerve paraesthesia over the anterolateral thigh is common after this approach and is not a complication.
Knee replacement.
- Full extension is the first priority and it is far harder to regain after six weeks than to maintain before it. Prone hangs, extension boards, heel props. A fixed flexion deformity at six weeks is the single most common avoidable disappointment.
- Flexion progressed as swelling allows. Cycling once the pedal will turn, initially part revolutions.
- After a subvastus approach the extensor mechanism is intact, so quadriceps work can usually progress sooner and straight leg raise is generally achievable earlier.
- Swelling and warmth persisting to three months is expected and is not in itself a sign of a problem. Warmth without other features is not infection.
- Hydrotherapy is useful from wound healing, typically about two to three weeks, and it is particularly valuable in the heavier or more apprehensive patient.
Milestones worth measuring.
- Two weeks. Knee: extension to zero or close to it, flexion around 90 degrees. Hip: independent with crutches, safe on stairs.
- Six weeks. Knee: full extension, flexion approaching 110 degrees, good quadriceps control, minimal extensor lag. Hip: unaided gait, or close to it.
- Three months. Knee: flexion 115 to 125 degrees for most, functional stair descent. Hip: endurance and single-leg control.
- Twelve months. Both: the result is largely settled, though swelling and the last of the stiffness can improve past this point in the knee.
When to contact the rooms.
Call rather than wait if you see:
- A wound that is discharging, reddening or newly painful after having settled, or a fever. Suspected infection is never a nuisance call.
- Calf pain or swelling disproportionate to the stage, or new shortness of breath.
- Sudden loss of range that had been improving.
- Knee flexion stalling below 90 degrees at six weeks, or an extensor lag that is not resolving. This is the referral that matters most: the window in which a manipulation under anaesthetic works well is measured in weeks, and late referral closes it.
- Pain that is escalating rather than settling after the first fortnight.
Early contact is easier to act on than late, in every one of those.
Return to activity.
Walking, swimming, cycling, golf, doubles tennis, hiking and most gym work are all reasonable after either operation. Running and repetitive impact are generally advised against, because impact accelerates bearing wear rather than because the joint will fail on the day. Kneeling after a knee replacement is often uncomfortable and is not harmful; it is worth setting that expectation early.
This page provides general information about a medical condition and a surgical procedure. It is not individual medical advice and does not replace consultation with a qualified practitioner. Outcomes vary between individuals and all surgery carries risk. A referral is needed for a consultation with Professor Daevyd Rodda; without one, you can start with the practice nurse practitioner, who can provide it.