Pre-operative Physio

Posted 30 November 2016 in Therapies

Patients often report to physiotherapy prior to surgery, unsure on with what they should do before their surgery. What should they be taught; does doing pre-operative rehabilitation really assist in their recovery? These are constant questions being asked and now due to shorter stays post-surgery, the role of pre-operative care is more important than ever. It is expected that THR and TKR procedures will continue to rise in number putting more strain on our rehabilitation system. In a clinical setting it is understood that exercise alone is imperative in managing pain and movement prior to any joint replacement.

As health professionals commonly prescribe exercise as a pre-operative tool, is there actual evidence for its success? Numerous trials have been conducted showing some statistical significant improvements with self reported questionnaires, pain and function after 6 weeks of land and pool exercises. Despite THR showing better outcomes than TKR, both showed that preoperative exercises improved discharge post surgery (1). Another study consisting of resistive exercise, hydrotherapy and stationary cycling, two times per week for an eight-week period found clinically important differences in post surgery outcomes ranging from strength, ROM, self-reported function and gait parameters (2). CVD, obesity and diabetes are all risk factors for complications post surgery. Evidence has linked obesity, other joint diseases, mental health status and metabolic syndrome to undermine functional outcomes and QOL post THR, TKR. One study showed obese individuals improved function and mental health scores post replacement, however postoperative complications significantly rose, in non-obese individuals this didn’t (3,4).

As outlined it is important to promote exercise whether it be hydrotherapy or land based program and identify those who require additional guidance from a physiotherapist to identify deficits in neuromuscular and kinetic chain, which are all important aspects of movements. By improving strength, CV fitness, ROM earlier in the pre-operative period and by empowering a patient to take an active roll in their preoperative management, this will assist them both physically and psychologically and allow them to get the desired outcome from surgery.

Central Physio Bayswater, offer a range of services and software that allows for a thorough assessment and treatment so a patient can achieve their preoperative goals and develop a successful postoperative outcomes.

Abbreviations Used

  • TKR: Total knee replacement
  • THR: Total hip replacement
  • ROM: Range of motion
  • CVD: Cardio vascular disease
  • QOL: Quality of life

References

  1. Rooks DS, et al. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum. 2006; 55(5):700-708.
  2. Ackerman IN, Bennell KL. Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review. Australian J Physiotherapy. 2004; 50:25-30.
  3.  Dowsey, M.M., et al. (2010), The impact of preoperative obesity on weight change and outcome in total knee replacement: A prospective study of 529 consecutive patients. Journal of Bone and Joint Surgery – Series B 92(4): p. 513-520. 115.
  4. Dowsey, M.M., et al (2010), The impact of obesity on weight change and outcomes at 12 months in patients undergoing total hip arthroplasty. Medical Journal of Australia. 193(1): p. 17-21.
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