How to rehabilitate after knee or hip surgery?

WHAT AFTER KNEE OR HIP SURGERY?

Surgery can sometimes be terrifying. Am I going to be able to walk? Am I going to have to walk with crutches? Fear not! We spoke to sympathetic physiotherapist Douwe Willaert. He answered all the pressing questions about the rehabilitation process after knee or hip surgery."  

By Lennert Suykerbuyk

How long does rehabilitation take after knee surgery?

D. Willaert: On average, this takes about six weeks, although rehabilitation is divided into several milestones. After two weeks, most patients are already able to walk around the house with two crutches.

After four weeks you may switch to a crutch and after six weeks you should be able to walk without crutches. Although the final course of rehabilitation still depends on the patient. For instance, it will often take longer for someone of 85 than for someone of 50. If it works at the physiotherapist and the body does not protest, I see no reason to delay it further.

After the fourth week, however, it is important that the patient wears the crutch on the healthy side. Many people often mistake this. For example, if you have had surgery on the left leg, you should use your crutch on your right side. When you then step forward with your 'healthy' leg, you thus nicely divide the weight between your operated leg and the crutch. This way, you avoid relying entirely on the operated leg.

During this process, you also learn to go back up and down stairs. Here, though, there is a difference between the knee and the hip. For example, it is more difficult for someone after knee surgery to go down stairs. Also, both hip, knee and ankle joints need to be maintained during both knee and hip surgery.

Of course, the treatment that body parts receive is different depending on the surgery. For example, if you have had knee surgery, your hip is not going to be restricted. Then you have to maintain good mobility of the hip.

What kind of exercises should you do during rehabilitation?

D. Willaert: After knee surgery, you will lie down in the Kinetec on the same day. This device will very slowly flex your joint at a constant rate. Five days after surgery we practice so that the patient can bend his knee 70° or 80°. Although this may take longer depending on the patient. All this is done in the hospital.

Once he can walk with two crutches, the patient is allowed to go home and mobility exercises begin. These are the same at both knee and hip. Then the physiotherapist starts helping with mobility. The patient then learns to bend his knee first 90° and then finally 120°. From then on, you are functional. Although this also depends on the patient's age. Someone in their 70s will set lower goals than a 20-year-old.

As mobility improves, we focus on strength. Although, of course, there is overlap between the exercises. Thus, during the mobility exercises, you also start doing strength exercises. In the first weeks, these exercises will be quite light such as stretching your knee on a table. The aim of this is to prevent further loss of strength. When mobility goes well, real strength training will follow. This is necessary because if you lie still for too long, you are not going to be able to stand up easily or walk up stairs.

Parallel to the strength exercises, you will also practice your balance. The exercise that helps with this is called weight shift. First you lean on your good leg. Then you gradually shift your weight to your operated leg until it is evenly distributed. Then you start supporting your 'bad' leg even more. If that works, you start putting your two feet together, then stand on one leg and finally stand on an odd mat.

Then you start combining the three components, mobility, strength and balance. Then you learn the functional actions like stepping, going to the toilet and picking things up off the ground. Although that is only before the end of rehabilitation.

Although, of course, there is a difference here between the hip and the knee. With the hip, depending on the prosthesis, you may not rotate outwards or inwards. That depends on the surgery, so I cannot give any guidelines on that. After hip surgery, for example, kicking exercises are very important.

For both knee and hip surgery, it is also important to maintain foot mobility. After all, for the first few weeks, you are lying in bed and cannot step. It is therefore also important to stretch the calves.

How important is a physiotherapist in this process?

D. Willaert: It depends mainly on how much the patient exercises at home. After knee surgery, the physiotherapist should be there anyway because in the beginning there are still risks when exercising. It is much easier to mobilise the knee with a physiotherapist than if you have to do it alone.

He can also tell you what not to do yet. After the end of rehabilitation, the patient can take more responsibility himself. If he exercises well at home, the patient will only have to go to the physiotherapist once or twice a week. Although it is still important that the physiotherapist follows up. Most can stop when they can walk again.

With hip surgery, there are certain exercises that the physiotherapist is better at. For example, in kicking exercises, you have the risk of the patient pushing the knees together. This is dangerous, which is why it is better for a physiotherapist to supervise.

So what kind of exercises should you do at home?

D. Willaert: It depends on where you are in your rehabilitation. At the beginning, during mobility, the patient should mainly put ice on the knee. Because otherwise, because of the swelling and pain during kine, you won't be able to do exercises. After that, you have to do the pendulum movement to keep your knee flexible. This movement involves letting your leg hang over a chair and doing rocking movements. For mobility, stretching exercises are also very helpful.

For strength exercises, we start simple like stretching the knee, pushing the knee against a table or sliding across the bed. Although there is a difference here between knee surgery and hip surgery. After hip surgery, on the contrary, you should avoid outward movements. Depending on the prosthesis, turning outwards or turning inwards is also prohibited. The further you are in the rehabilitation process, the more you can do at home. Balance exercises are sometimes a bit more difficult, especially with older people. They might fall and you want to avoid that. Balance is best done with supervision. The best thing you can do at the end of your rehabilitation is steps. Then you combine strength, balance and mobility.

I myself also always ask my patients if they do the exercises. Because I usually notice whether they have done their homework or not (laughs). Then they should repeat the exercise once to check if they are performing it correctly.

What actions are best to avoid when rehabilitating.

D. Willaert: It depends on the operation but in general, I would not do any actions that have not already been offered in the cine. At home, it's better to do less challenging exercises so as not to do anything wrong.

With a hip prosthesis, you should especially avoid turning your leg outward or all the way in. Because otherwise there is a high risk of your prosthesis dislocating.

For the knee, there are no dangerous movements. Above all, you have to listen to your body. For example you take a walk that is way too big. As a result, you will suffer a major setback. Still, there are no specific movements you should avoid. Just don't overdo it.

There is always a tip I give to patients when taking care of the scar, though. Here in West Flanders, people think you have to put Nivea on the wound. You should only do that when the wound is closed. When there is still a scab on the wound, it is still open and the wound can get infected.

Are there any aids that could make rehabilitation more pleasant?

D. Willaert: After surgery, patients often wear support stockings on the non-operated leg. This prevents blood clots in the legs in older people. As soon as people leave the hospital, most people take those stockings off again.

Walking aids are also very important. Most people use normal elbow crutches although, of course, you can also use a walking stick.

Towards the end of rehabilitation, patients are also given a stretcher. With that, they can exercise at home. Other than that, I can't really come up with another tool.

Have you perhaps heard of the MySleeve?

D. Willaert: No, what is?

A cover that you stick on the handle of the crutches. This gives the user a better grip on the crutch. It also includes a magnet so you can hang the crutches against each other.

D. Willaert: That's handy, though. Something I hear a lot from patients is that when they want to put themselves down, the crutches fall on the floor. Nice to discover such a solution exists, thanks!