A total knee or hip replacement is a surgical procedure whereby the diseased knee or hip joint is replaced with artificial material. Physiotherapy is an essential part of both the pre and post operative phase.
The knee is a hinge joint which provides motion at the point where the thigh meets the lower leg. During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the lower leg bone (tibia) is also removed and replaced with a metal stem. Depending on the condition of the knee cap (patella), a plastic insert may also be added under the patella surface. During the procedure, the knee ligaments which stabilize the knee may be retained, or substituted by artificial material.
The hip joint is a ball and socket joint. The socket is a cup shaped bone of the pelvis called the acetabulum. The ball is the head of the femur. A total hip replacement involves surgical removal of the diseased ball and socket, and replacing them with a metal ball and stem inserted into the femur and an artificial plastic cup socket. The prosthesis is either fixed with a bony cement, or alternatively a cementless prosthesis is used that has microscopic pores which allow bony ingrowth from the normal femur into the prosthesis stem.
Total joint replacement surgery is considered in patients whose hip or knee joints have been damaged by arthritis, trauma or other destructive diseases of the joint. Osteoarthritis tends to be the most common cause of replacement surgery.
Regardless of the cause of damage to the joint, the symptoms tend to be debilitating and include progressive pain and stiffness, and decreasing daily function.
Pre operative physiotherapy can assist in maintaining joint range of motion and improving muscle strength to ensure the best outcome post surgery. Post operative physiotherapy usually beginning 24 to 48 hours following surgery. The main aim is to restore normal joint range of motion and stability, and increase muscle strength. The ultimate aim being to return the individual to normal function and daily activities as soon as possible. In most cases, very little hands-on physiotherapy is required post-operatively. The most common requirement is exercise guidance and reassurance that the recovery is progressing as expected. Occassionally, patients who have had a total knee replacement, and are slow to regain the necessary movement, require some passive stretching treatment from a physiotherapist. Our physiotherapists are experienced in the assessment and treatment of patients pre and post-operatively.
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The Independent General Practice