News & Advice

Before your joint replacement, did you notice your hip or knee before it wore out?

A common issue we see at Physiofusion is confused and frustrated patients that have had replacements (like hips and knees) but that have never seemed to recover to the point they expected. They are still in pain or still can’t return to the sport they loved (and was the reason for their operation in the 1^st place) or still feel weak or ‘malaligned’ on that side…and the list goes on.

Why Your Joint Replacement Has Stalled?

Most people expect a straightforward recovery after their joint replacement. Surgery done, new joint in, back to normal. But for a lot of people, (somewhere between 3 and 6 months) things plateau. Progress slows, confidence drops, and life still feels restricted. The surgery worked. The surgeon has confirmed the joint is ‘perfect’ so why doesn’t it feel like it?

The answer is usually one (or more) of these things:

1. Soft tissues around the joint (they didn’t replace those!) are irritated
2. The mechanics of the leg have not normalised, e.g; the motion is incorrect
3. There is tightness in some structures and weakness in others
4. There are underlying issues with balance or stability around the joint

Things To Consider Post Joint Replacement

Modern joint replacements are built to be loaded, so weight bearing is important. The implant needs progressive stress through it to integrate properly and the muscles around it need to be challenged to rebuild strength. Gentle walking and basic exercises get you started, but they won’t get you to where you want to be long-term. You will be fit to ‘basic level’ and likely not the level of fitness required for all of your lifes challenges.

At the 3 month point, most people should be working on single leg strength, progressive loading, return to perfect movement patterns, balance and stability training. If you’re still doing the same exercises you were given initially, it’s catch up time. Or something hasn’t got to plan.

Pain is not necessarily anything to worry about. Recovery stalling is not a sign anything has gone wrong either. It’s usually a sign the rehab hasn’t kept pace with where the tissue actually is.

 

Common Questions on Joint Replacement Answered:

 

Q: I’ve been to my surgeon and they said everything looks perfect on my X-ray but I’m still in pain 4 months down the line. Is that normal?

This is a very common event. And yes it’s very normal. Your body is still healing from the operation even at this time. It’s still structurally ‘bedding in. The scar is still changing and hopefully slowly ‘loosening off’. The muscles and ligaments have been surgically accessed to put the prosthetic in and are still developing strength. Remember also that the old habits of how you had to move with your worn and torn joint will also need retraining out to normalise movement and some structures may be tighter now than before your original worn joint. What matters is the overall direction of travel. If things are gradually improving week on week, you’re on track. If pain is not improving or worse still increasing, that’s worth discussing with your physio

 

Q: I was told to avoid certain movements because the joint could pop out?

Hips are the most prone joint replacements to dislocate and so you will be advised to not flex them beyond 90 degrees or take the hip into adduction (across your body central line). This is especially important in the 1^st 12 weeks and probabilities of dislocation reduce over the following months. Your physio will be able to advise when your personal joint is able to move into the directions and angles that previously you should have been cautious of.

Knee replacements don’t have these seem cautions. The joint is much less likely to dislocate and, quite the opposite to the hip, movement is very much encouraged to the fullest extent pain allows.

 

Q: How do I know if the pain I feel during exercise is safe to push through or a sign to stop?

A useful rule of thumb is the 24 hour rule. Pain or soreness during or after exercise that settles back to your baseline within 24 hours is generally fine to work through. It is a normal response to tissue stretch or load. If pain spikes significantly during an exercise, does not settle overnight, or leaves you worse than you started the next day, it is a signal to modify the exercise rather than push on. The goal is to find the edge of your capacity and build from there, not to avoid discomfort entirely, but to make sure the response of your tissues is optimal.

 

Q: I don’t feel things are as good as they should be and don’t feel confident to go alone with my home rehab….

That’s ok. Help is at hand. We can assess the new joint. Let you know how its getting on in our professional experience. Answer any questions. Provide any post-op treatment the joint would benefit from (for example soft tissue release). Review your home rehab program and try to get it back on track and appropriate for the time scale following the operation. Provide you with personalised reassurance based on your body, its assessment findings and not ‘Google’ averages!

 

As always, if you have any questions or queries. for us regarding your joint replacement, you can reach out to us for free using our Ask A Physio service, here. Our experienced therapists aim to get back to you within 24 hours.