A new hip or knee can be a new lease on life, but getting recovery right means getting back to the things you love even faster. Lorraine Harris, Physiotherapy Manager at Nuffield Health Tunbridge Wells Hospital, explains.
To make hip and knee replacements successful, we need to begin your recovery as soon as you’re able. Soon after your operation, a physiotherapist like me will visit you on the ward. Here’s what happens next.
Day 1 – 2: Getting back on your feet
This simple task is our first objective. Using a Zimmer frame, we’ll try to get you on your feet as soon as possible. For hip patients, that’s sometimes on the same day as your surgery, depending on the effects of the medication, alternatively we will get you up the following morning. We will usually try to have you walking up and down the corridor with the frame the day after surgery too. Knees typically take a little longer to recover from so we’ll let you rest overnight before attempting to stand.
Day 2 – 4: Going mobile
After you’re on your feet, it’s time to get moving. Getting mobile is all about confidence, that’s why we help you to progress through a range of walking aids until you’re independent, starting with a Zimmer frame. The frame gives optimum stability by supporting your full weight. This way you’ll be able to test the strength of your new hip or knee with minimum risk of losing your balance.
Once you’re able to comfortably put more weight on the new joint we’ll move you on to crutches to help normalise your gait and increase the amount of distance you can cover. Some patients are discharged with crutches, others move on to walking sticks – it’s all about personal preference.
You’ll also be guided through a range of exercises to do in bed, so you’re still making progress even when you’re not on your feet.
Final day in hospital: Become a stair master
To be truly independent we need to know you can manage stairs and other awkward spaces, so we’ll train you to do it safely.
- Use a handrail where possible with a walking aid in the opposite hand;
- If going down stairs: Move the crutch/stick onto the lower step, put your weight on the crutch/stick as you move your operated leg onto the step alongside it;
- Bring your non-operated leg onto the same step and repeat. Do the opposite on the way back up.
Once you’ve mastered the stairs and you’re ready to get going you can be discharged from hospital once the consultant is happy that you are medically fit. At Nuffield Health there are no limits on your aftercare. Even once discharged, your recovery has only just begun. We’ll prescribe a set of exercises for you to do at home. Every programme is different, but here are a few exercises I regularly ask patients to do:
Knee replacement recovery exercises (10 reps each x 3 sets a day)
- Stair lunges: stand at the base of the stairs and place you’re operated foot on the first stair. Lunge forward slowly bending at the knee only as far as is comfortable.
- Bed exercise: push the knee flat into the bed to ensure full straightening of the knee.
- Mini-squats: stabilise yourself by holding on to a kitchen bench, door frame or heavy table. Keeping your back straight, lower you buttocks bending at the knees. Only go as far as is comfortable.
Hip replacement recovery exercises (10 reps each x 3 sets a day)
- Knee lifts: Stabilise yourself by holding on to a doorframe or kitchen top. Stand on your good leg and keep the knee straight. Slowly lift your operated knee up to 90 degrees to the level of your hip and lower back down.
- Side leg lifts: Standing in the same position, put your weight on your good hip and lift your operated leg out to the side, keeping the knee straight.
- Reverse leg lifts: Same as above by lifting your operated leg out behind you as far as is comfortable with a straight knee.
We usually follow up with knee replacement patients at the two week mark when they come back to have their stiches removed. Hip replacement patients often need no follow up at all and are fine just continuing with the home-based exercises along-side increasing their walking distances, both in and outdoors.
Further physiotherapy sessions are based on clinical need and vary from patient to patient.
Nuffield Health takes a joined up, end-to-end approach to healthcare with Recovery Plus. Your physiotherapist can refer you to the programme after being discharged from their care. You’ll get three months free access to your local Nuffield Health Gym with monthly Health MOTs and support from a Personal Trainer.
Some take home tips
You’ll soon be enjoying all the benefits of your new hip or knee. But remember:
- Do little, often. A full recovery takes around 9 – 12 months. It sounds like a long time but it’s a gradual process until one day, life before your new hip or knee seems a distant memory;
- Listen to your body. No one knows your body like you do. If it doesn’t feel right, follow up with your Consultant or physiotherapist. Don’t be afraid to be honest about your progress and how you’re feeling;
- Be aware of DVT. Deep vein thrombosis (DVT) is a rare side-effect post-knee and hip surgery. If your calf becomes swollen, inflamed, or painful seek medical advice as soon as possible;
- Stay cool. Use ice where necessary to decrease pain and swelling for knee patients (we usually provide a cryocuff for you to take home for this).