Physiotherapy and Joint Replacement Surgery

Physiotherapy helps people delay the need for joint replacement, and helps them prepare for and recover from the surgery itself.

• Physiotherapy-led exercise can reduce pain and improve physical function while you are waiting for surgery.
• Physiotherapy after surgery reduces pain.
• Physiotherapy after surgery increases range of motion.
• Physiotherapy reduces costs by delaying or decreasing the need for surgery.

The role physiotherapists play

Physiotherapists support Canadians who are waiting for, undergoing and recovering from a range of orthopaedic surgeries. For patients anticipating a total knee or hip replacement in particular, physiotherapy leads to improved health outcomes, shorter hospital stays, earlier and faster recoveries, and lower costs.

Patients report strong satisfaction when physiotherapists are involved in their recovery after surgery, and they respond well to pre-surgical training programmes too.

The evidence supports physiotherapy across the whole path: pre-operative education, inpatient rehabilitation and community-based services. Effectiveness studies show that patients who had a joint replacement and took part in a physiotherapy programme did better, with the greatest gains from early intervention — rehabilitation starting 24 hours after surgery.

What the studies show

• Exercise-based physiotherapy can reduce pain and improve physical function for people waiting for hip replacement surgery.
• After the operation, those who took part in physiotherapy programmes had better outcomes — less pain, more joint range of motion.
• Physiotherapy can delay or reduce the need for surgery through appropriate conservative management, which saves the health care system money.
• Physiotherapy triage of patients referred for surgery gives more care options and improves patient satisfaction.
• Screening and triage reduces costs by cutting inappropriate specialist referrals — 34% of patients turned out not to need surgery at all.

References

• Coudeyre E. et al. (2007). “Could preoperative rehabilitation modify postoperative outcomes after total hip and knee arthroplasty?” Ann Readapt Med Phys, 50(3), 189–97.
• Dorr L.D. & Chao L. (2007). “The emotional state of the patient after total hip and knee arthroplasty.” Clin Orthop Relat Res, 463, 7–12.
• Herck P.V. et al. (2010). “Key interventions and outcomes in joint arthroplasty clinical pathways: a systematic review.” Journal of Evaluation in Clinical Practice, 16(1), 39–49.
• Canadian Physiotherapy Association (2012). The Value of Physiotherapy | Joint Arthroplasty.
• Gill S.D. & McBurney H. (2013). “Does exercise reduce pain and improve physical function before hip or knee replacement surgery?” Archives of Physical Medicine and Rehabilitation, 94(13), 164–76.
• Grotle M. et al. (2010). “What's in team rehabilitation care after arthroplasty for osteoarthritis?” Physical Therapy, 90(1), 121–31.
• Oldmeadow L.B. et al. (2007). “Experienced physiotherapists as gatekeepers to hospital orthopaedic outpatient care.” Med J Aust, 186(12), 625–628.
• Aiken A.B. et al. (2008). “Easing the burden for joint replacement wait times: the role of the expanded practice physiotherapist.” Healthcare Quarterly, 11(2), 62–66.

Provided by the Canadian Physiotherapy Association for National Physiotherapy Month.