Total joint replacement (arthroplasty) is a common surgical intervention that is performed for severe arthritis when conservative treatments are ineffective. The goal of replacement surgery is to relieve pain, improve joint mobility, and restore or improve a person’s ability to safely perform functional activities. Glinn and Giordano’s Physical Therapists work with people who have had a joint replacement to increase range of motion (ROM), teach improved movement strategies, strengthen muscles and restore functional movement patterns to their highest potential.

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Before surgery
We will help educate you about what to expect from your surgery, and give you exercises to condition your body before surgery.

In preparation for surgery, we teach you:

• Flexibility and strengthening exercises for the upper and lower extremities
• How to use a walker or crutches for walking and for navigating steps for lower extremities surgeries
• Any precautions to take after surgery

We also may recommend that you make changes in your home to improve safety and help your recovery, including the use of a raised toilet seat, handrails on stairs, a bed rail, and a tub seat or grab bars in the shower. These changes ideally should be made before you have surgery, so your home is prepared for your return.

We have found with physical therapy interventions before surgery the recovery post-operative care is reduced. Patients achieve their goals and return to normal activities of daily living several weeks prior to those who do not attend pre-operative physical therapy.

After surgery
We will remind you of any postsurgical precautions to take to prevent re-injury and to help restore your full function.
Depending on your particular case/surgical procedure, you may be asked to limit the amount of weight/stress you put on the surgical extremity. We will teach you how to correctly put weight on the affected leg, and will recommend an assistive device, such as a walker or crutches, to minimize discomfort as you work to restore your physical function. We will then let you know when you can stop using the assistive device while walking. You may also have range of motion limitations by your surgeon to protect the healing joint. We will review the positions that can be disruptive to the healing joint capsule and ensure the surgical joint does not dislocate.
Different exercises are prescribed at specific points after surgery. Glinn and Giordano Physical Therapy will teach you the ones that are best for you at each stage of your recovery.

Your treatment plan may include:
Range-of-motion exercises. We will assist you with gentle movements in different directions to aid healing. These may be passive movements, which your PT will perform for you, or active movements you do yourself. We will also teach you gentle exercises to perform at home.

Strengthening exercises. As your mobility returns, we will guide you through a strengthening program. When the time is right, you may use resistance bands and/or weights to perform gentle strength-building exercises.

Functional training. We will help you regain everyday functional movements. This will involve teaching you how to safely perform activities that are important to you for your self-care. Be sure to tell us the areas of your life that are important to you. We will design your treatment program for your specific needs.

Job and sport-specific training. As your strength and movement increases, we will design a custom program to help get you back to your job tasks or hobbies. You also may receive sport-specific training if you are planning to return to a sport. We will create a home or fitness-center exercise program based on your personal needs.

Early physical therapy after surgery will focus on pain reduction, swelling reduction and increasing range of motion.

Total Hip Replacement
Hip replacement surgery has a delicate and lengthy recovery time, so it is vital that a patient strictly adhere to the recommendations set forth by the surgeon. A few days after a successful hip replacement surgery, a patient is usually discharged from the hospital. To care for your new hip and keep it from sliding out of position, you will need to follow a few general restrictions at first. Your surgeon may recommend some additional restrictions based on your condition and type of surgery before the rehabilitation process begins. For example, the following is recommended for a posterior approach total hip replacement.

• DO NOT lift your hip more than 90 degrees, which
  includes not bending over more than 90 degrees to put on socks/shoes.
• DO NOT cross your legs
• DO NOT turn your leg inward, which includes turning outward with your foot fixed on the ground.

Physical therapy is a very important part of your healing after surgery and will help in restoring strength in the replaced hip. During physical therapy we will work on allowing a 90-degree (flexion) of the hip with rehabilitative exercises. You will need to be able to bend 90 degrees to be able to do things like get in and out of a car easily. You will also need to get your leg to move out to the side and backwards. It is important to work hard during these sessions to achieve optimal range of motion and strength in your hip to receive the full benefit of your new joint. Your commitment to your exercise program is the key to your full recovery. The stronger your muscles are, the more they can support the use and movement of your new hip.

Total Knee Replacement
A patient is usually discharged from the hospital one to three days after a successful knee replacement surgery. The goal of the Total Knee Replacement Program is to return a patient’s knee(s) to normal knee function, which will be achieved by:

• Allowing a complete extension of the knee
• Advancing flexion to a 120-130 degree of bend
• Increasing hip, knee and ankle strength

You will need to be able to bend at least to 110 degrees to be able to do things like get in and out of a car easily.
You will also need to get your knee fully extended. Getting your knee straight is just as important as getting it to bend. If you do not have full extension, you won't be able to get your heel down all the way when you walk.
Physical therapy is a very important part of your surgery. You must work hard to achieve full flexion and extension in your knee to receive the full benefit of your new joint. Your commitment to your exercise program is the key to your full recovery. For the maximum function of your new knee, you must stretch and strengthen the muscles around your knee. The stronger your muscles are, the more they can support the use and movement of your new knee.

Total Shoulder Replacement
After a successful shoulder replacement surgery, two to four days of hospital recovery time is normal before a patient is discharged. The Total Shoulder Replacement Program will allow the patient to take full advantage of their new joint by:
It is important to understand regaining a functional range of motion for your new shoulder joint will not be the same as your previous “normal” shoulder. Overhead reaching may be limited by the type of replacement joint the surgeon uses, but getting 80% of your overhead range of motion back is a good goal to aim for. There will be some early restrictions to protect the joint including:

• Do not rotate your arm passively outward
  (external rotation)
• Do not pull inward forcefully against resistance (internal rotation)
• Do not reach behind your back

Rehabilitation exercise should help strengthen your shoulder, improve range of motion and reduce scarring so that you can get back to your normal activities sooner. Physical therapy is a very important part of your surgery. While patients whose jobs do not involve overhead lifting may resume work and moderate exercise within a relatively short time, depending on the procedure, quite frequently patients do require months of rehabilitation. You must work hard to achieve full motion in your shoulder to receive the full benefit of your new joint. Your commitment to your exercise program is the key to your full recovery. For the maximum function of your shoulder, you must stretch and strengthen the muscles around your shoulder. The stronger your muscles are, the more they can support the use and movement of your shoulder. If you have a Reverse Total Shoulder all the above apply but you will not have the rotator cuff strength to reach outward against resistance (resistive external rotation exercises). We will teach you which muscles to strengthen to make up for the lack of rotator cuff.

We look forward to helping you regain your freedom and independence that come with these life changing surgeries so you can live the life you want to live.