How to Recover Faster After Joint Replacement Surgery for Arthritis By Nathan Wei
Findings from a recent study indicate that for osteoarthritis patients, an exercise program will allow a faster recovery following joint replacement surgery.
Researchers from Harvard Medical School (Boston’s New England Baptist Hospital, and Beth Israel Deaconess Medical Center) studied 108 men and women with severe osteoarthritis scheduled for total hip or knee replacement surgery at Boston’s New England Baptist Hospital. Patients were typically in their late 50s to late 60s.
The researchers randomly split the patients into two groups.
Patients in one group followed a six-week exercise program before their operation. The other group was not asked to exercise before surgery.
The exercise group performed workouts three times weekly for six weeks and were monitored carefully to make sure the exercise was commensurate with their physical condition.
For the first three weeks, patients in the exercise group worked out in a pool, the reasoning being that the natural buoyancy of the water made water workouts easy on the joints. The patients stood in chest-deep water, exercising all of their joints.
For the last three weeks, patients exercised in a gym on recumbent stationary bikes or elliptical machines. These particular pieces of equipment are low impact.
Patients also did strength training and stretches for flexibility during the program’s last three weeks. A physical therapist supervised the workouts, which lasted 30-60 minutes and were held at a community fitness facility.
Prior to the study, patients rated their ability to do normal chores and activities. They also took tests of balance, mobility, and leg strength. These tests were repeated right before surgery, and also afterwards. Exercisers having hip replacement surgery improved their function and pain scores before surgery.
Patients in the exercise group, both hip and knee replacement patients, increased leg strength by an average of 18% to 20% (leg-press scores) pre-surgery. Post-surgery, the exercise group reduced the odds of being discharged directly to a rehabilitation facility rather than going home by 73%. Similarly, 76% of the exercisers were able to walk 50 feet on the third day post-surgery compared with 61% of non exercisers. The researchers also noted that patients who exercised reported being well prepared mentally for their rehabilitation. This was in part because they were no longer afraid of exercise and they understood from first-hand experience how important it was.
Sixty-five percent of the exercisers were able to go straight home, compared to 44% of the non-exercisers, the study showed.
Exercisers who got total hip replacement also showed a significant advantage in their pre-surgery function — based on their own ratings of their ability to handle routine activities — compared to the non-exercisers.
However, no functional benefit was seen in exercisers who had their knees replaced.
The reasons for that aren’t clear, the researchers noted, although they said the difference may have been related to the joint location. A longer period of exercise may be needed to help knee function was one hypothesis put forth by the researchers.
The conclusions were that “an appropriately designed program of water and land-based exercise involving cardiovascular, strength training, and flexibility activities can be a safe, tolerable, and effective approach to improving muscle strength in middle-aged and older adults with severe osteoarthritis of the hip and knee.”
Author’s note: it is important that any exercise program be OK’d by your physician, designed by the orthopedic surgeon or another representative of the surgical team, and supervised by a physical therapist.
(Rooks DS et al. Effect of Preoperative Exercise on Measures of Functional Status in Men and Women Undergoing Total Hip and Knee Arthroplasty. Arthritis Care & Research. 2006; 55(5): 700-708).
This article was adapted from a news release from the Arthritis Foundation.
Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland (http://www.aocm.org). He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: Arthritis Treatment