General practitioners play a crucial role in guiding patients through various stages of medical care, including post-joint replacement recovery.
Joint replacement surgeries offer tremendous relief and mobility improvements for individuals suffering from chronic joint pain and dysfunction. However, optimising the outcomes of these surgeries often requires comprehensive rehabilitation strategies, with physiotherapy standing as a cornerstone in this process.
As advocates for patients’ well-being, it is imperative to recognise the integral role of physiotherapy in joint replacement recovery. One of the primary objectives of physiotherapy following joint replacement is to facilitate early mobilisation and functional independence. Through targeted exercises, manual therapy techniques and assistive devices, when necessary, physiotherapists empower patients to regain strength and mobility.
In the context of total knee replacement (TKR) recovery, facilitating patients to regain their range of motion is vital to satisfactory, long-term outcome. Rehabilitation of TKR patients is simple but not easy, as the methods for achieving an improved range of motion are established and straight forward, but the process can be physically painful for the patient.
Through manual therapy techniques, appropriate load management principles and education, physiotherapists are well placed to optimise what patients can achieve, despite their pain.
Usually, when pain is experienced, it is associated with damage. Thorough education on the difference between hurt and harm in this setting is vital to ensuring patients can optimally approach the challenge of stretching a healing knee incision. Time is a pertinent factor here as if stretching is avoided following the TKR procedure, proliferating scar tissue at the incision site can become mature, adhering the quadriceps to the femur reducing potential for later range of motion improvements.
Following this timeframe (8-12 weeks), not only is physiotherapy going to be far less effective, but also the window of opportunity for specialist intervention (via manipulation under anaesthetic) is rapidly closing. Care needs to be taken here to ensure the patient balances their loading of the knee – too much forceful, aggressive rehabilitation (common in younger, more active individuals undergoing TKR surgery) can be counter-productive and put patients at risk of complications like arthrofibrosis.
Timely intervention and continuity of care are essential elements in achieving optimal patient recovery and long-term joint health. Incorporating physiotherapy referrals as standard practice post-joint replacement surgery is always in the patients’ best interest. In the event a patient is progressing at a satisfactory rate, it is far easier to reduce input from physiotherapy than convince a patient to increase their involvement with physiotherapy later in recovery.
If physiotherapy is not encouraged from the outset, later introduction of physiotherapy can be seen by the patient as an indication they
are ‘failing’ their rehab. Patients are also more inclined to be returning to normal activities later in the rehab process, meaning they have less time available for physiotherapy input and the attitude that ‘they have gotten themselves through so far’.
By encouraging patients to seek physio from the outset of recovery, its importance in rehabilitation is implied and compliance is much greater among patients.
Collaborative care between GPs and physiotherapists (especially joint replacement-specific physiotherapists) ensures comprehensive management, improving patient outcomes and reducing the risk of complications or setbacks.
Orthopaedic physiotherapy stands as a cornerstone in the rehabilitation journey following joint replacement surgery. By acknowledging its significance and fostering interdisciplinary collaboration, general practitioners can contribute significantly to the holistic care and well-being of their patients undergoing arthroplasty procedures.
Key messages
- Knee replacement recovery is simple, not easy. The goals of rehabilitation are non-ambiguous but can be painful to achieve
- Education by physiotherapists on pain during healing (hurt not meaning harm) should be prioritised early in the recovery process. Painful stretching is eased by physiotherapy input
- Early engagement with physiotherapy is key – input is always easier to dial back when not required. Patients are often reluctant to increase physio input once they start to fall behind.
Author competing interests – nil.