Post Surgical Physical Therapy
BSR Physical Therapy works closely with orthopaedic surgeons in order to achieve the best possible patient outcomes without complication. Below are some of the more commonly performed surgical procedures which we rehabilitate at BSR Physical Therapy.
Total Knee Arthroplasty (Replacement)
Total Knee Replacement (TKR), also known as a Total Knee Arthroplasty (TKA), is a surgical procedure commonly used to relieve knee pain due to arthritis or in some cases trauma related injury. TKR is a viable option when the individual’s function is extremely limited due to pain and when conservative care, an exercise program, and weight loss was not substantially effective in relieving symptoms. Greater than 600,000 TKR are performed each year with approximately 90% of individuals experiencing significant symptom reduction.
There are multiple surgical approaches with Total Knee Replacement with most common types being Traditional and Minimally Invasive Surgery (MIS). In both approaches the damaged cartilage and bone surfaces are removed and replaced with prosthetic implants. The Traditional approach will typically result in an 8-12 inch scar, whereas the MIS results in a 3-4 inch incision. Research suggests outcomes for both procedures are the similar over the long term, with fewer complications experienced with the Traditional approach.
Following TKR most individuals are fully weight bearing on the involved lower extremity, but will likely have to use an assistive device for a short period (walker, crutches, cane). Best evidence supports that patients receive outpatient orthopedic physical therapy where the focus is on restoring normal knee motion, strength training, normalizing walking patterns and restoration of prior functional/recreational activities. Your physical therapist will work with you targeting your greatest impairments and develop a plan of care to help you achieve your goals. The entire surgery and rehabilitation process is typically 12 weeks in length with continued functional gains made after 12 weeks by performance of a home exercise program. A recent study suggest that approximately 98% of individuals who undergo TKR will be able to return work, including heavy work activities. Depending on the type of work patients with sedentary jobs can return to their work tasks as early as 1 month after surgery, whereas more strenuous jobs may take up to 3 months. Patients can expect to realistically return to walking without an assistive device, swimming, golfing, driving, light hiking, biking, dancing, and other low-impact sports, However, outcomes are specific to each patient and is based on prior levels of function.
If you are considering undergoing a knee replacement, or have recently undergone this procedure, please call one of our physical therapists to learn more about your recovery and return to function.
Total hip replacement is a surgical procedure that is most likely performed on people who have severe osteoarthritis of the hip. Other possible reasons for a hip replacement include, rheumatoid arthritis, osteonecrosis, fracture, and bone tumor. Since 2003, the number of hip replacement surgeries performed has increased by 33% in the United States. The most common age groups receiving hip replacements are people over 70 years of age.
There are 2 main surgical options for a total hip replacement; a posterior approach and an anterior approach. The type of surgical approach is typically determined based on physician preference. The anterior approach is a fairly new procedure which requires the surgeon to cut less muscle which some believe results in a faster recovery time. The posterolateral approach has been done for a longer period of time. One of the biggest risks following total hip replacement is dislocation. This complication has been noted to occur with 1% of surgeries with anterior approach and 1.3% with posterolateral approach.
The typical course of treatment after total hip replacement could involve a short stay in the hospital and in some cases a short stay at an inpatient rehab facility. Upon returning home, a large percentage of patients undergo a period of outpatient physical therapy, which usually lasts 1-2 months. Outpatient Physical Therapy consists of a combination of manual physical therapy, supervised exercise to improve range of motion, strength training of the muscles around the hip, and functional exercises that are geared towards returning the individual to prior functional activities. At least one study shows that physical therapy had a positive effect on patients after a total hip replacement with faster recovery times and an increase in walking ability. Another study also found that physical therapy allows for an overall increase in functional status for patients who have received a total hip replacement.
If you are considering undergoing a hip replacement, or have recently undergone this procedure, please call one of our physical therapists to learn more about your recovery and return to function.
Freburger J. An analysis of the relationship between the utilization of physical therapy services and outcomes of care for patients after total hip arthroplasty. Journal of Physical Therapy. 2000;80(5):448-458.
Kishida Y et al. Full weight-bearing after cementless total hip arthroplasty. International Orthopaedics. 2001;25:25-28.
Jolles B, Bogoch E. Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis. Cochrane Database Systematic Review. 2006:3.
Maradit-Kremers H, Crowson C, Larson D, Jiranek W, Berry D. Prevalence of total hip (THA) and total knee (TKA) arthroplasty in the United States. Presentation. 2014.
National Institute of Arthritis and Musculoskeletal Diseases (NIH).
Ng CY et al. Quality of life and functional outcome after primary total hip replacement: a five-year follow-up. Journal of Bone and Joint Surgery. 2007;89(7):868-873.
Reverse Shoulder Arthroplasty (Replacement)
A reverse shoulder arthroplasty (RSA) or replacement is characterized by changing, or “reversing”, the position of the ball and socket so that the ball is on the socket side of the joint and the socket is on the ball side. In the normal shoulder, the rotator cuff muscles help the large deltoid muscle to raise the arm. When the rotator cuff is torn and non-functional, the humeral head (arm bone) “escapes” upwards within the joint, and the deltoid is then unable to lift the arm by itself. By reversing the position of the ball and socket the loss of the normal rotator cuff is compensated for and the deltoid muscle can once again raise the arm. RSA has been performed for over 25 years in Europe but has only been FDA approved in the United States since 2003. In 2011 approximately 1/3 of shoulder replacement procedures were RSA. Approximately 80% of patients who undergo RSA do so because of arthritis and rotator cuff-deficiency1. Another common and increasing indication is complex fractures of the upper part of the arm bone (humerus), accounting for about 10% of reverse shoulder arthroplasty’s1,2. Other indications include rheumatoid arthritis and revision arthroplasty.
Physical therapy following reverse shoulder arthoplasty is based on three important considerations: protecting the healing joint, maximizing deltoid muscle function, and establishing appropriate functional and range of motion expectations. Rehabilitation during the first 4 to 6 weeks following surgery focuses on joint protection strategies (including sling use), pain control and gradual restoration of range of motion. Joint protection is important to minimize the risk of complications following surgery. Shoulder dislocation is one such complication which requires care during the early phases of recovery. Movements such as reaching behind the back should be avoided or minimized due to the vulnerability of the shoulder to dislocate in this position following RSA. By the sixth postoperative week gentle deltoid and shoulder blade muscle strengthening exercises are initiated3. These exercises are important in order to regain functional use of the arm for activities of daily living (dressing, bathing, etc) and light athletic activities (tennis, swimming, etc)4. Normal full active range of motion following RSA is not expected in most cases. However we have witnessed some very impressive results where individuals have recovered to the same extent, or better, than their uninvolved shoulder. From our experience and the latest research, recovery of functional ROM is dependent on the patient’s pre-surgery status, the extent of rotator cuff damage, and the patient’s adherence with their home exercise program4-6.
If you are considering undergoing a reverse shoulder replacement, or have recently undergone this procedure, please call one of our physical therapists to learn more about your recovery and return to function.
Schairer WW, Nwachukwu BU, Lyman SL, Craig E V., Gulotta L V. National utilization of reverse total shoulder arthroplasty in the United States. J Shoulder Elb Surg. 2014;24(1):1–7.
Anakwenze O a., Zoller S, Ahmad CS, Levine WN. Reverse shoulder arthroplasty for acute proximal humerus fractures: A systematic review. J Shoulder Elb Surg. 2014;23(4):e73–e80.
Boudreau S, Boudreau E, Higgins LD, Wilcox RB. Rehabilitation Following Reverse Total Shoulder Arthroplasty. J Orthop Sport Phys Ther. 2007;37(12):734–743.
Simovitch RW, Gerard BK, Brees J a., Fullick R, Kearse JC. Outcomes of reverse total shoulder arthroplasty in a senior athletic population. J Shoulder Elb Surg. 2015;24(9):1481–1485.
Leung B, Horodyski M, Struk AM, Wright TW. Functional outcome of hemiarthroplasty compared with reverse total shoulder arthroplasty in the treatment of rotator cuff tear arthropathy. J Shoulder Elbow Surg. 2011:1–5.