Total Knee Lecture

Dr. Andrea Johnson-Davis, PT, DPT, MS, CCCE

Knee replacement surgery is a common surgical procedure that allows for an effective reduction of pain and adequate restoration of function for the vast majority of patients suffering from advanced knee osteoarthritis or other forms of arthritis. In 2003, more than 638, 000 hip or knee replacement surgeries were performed. In the last decades, the growing needs of the population have made this procedure, along with hip replacements, the second most popular orthopedic surgery.

The sharp rise in demand for these procedures has led to growing waiting lists. Waiting for knee replacement surgery represents a significant burden for patients as they experience great pain, suffer functional limitations and loss of health related quality of life for many months. To ease the anxiety and distress some patients feel during the period of time between being schedule for surgery and actually undergoing surgery, a pre-operative educational program may be helpful. Two recent studies have shown that education and rehabilitation while waiting for a total joint replacement have positive effects on the patient's health status and could lead to better outcomes postoperatively.

As an outpatient physical therapist, I see a number of patients who have undergone total hip and knee replacements each week. Most patients are seen within 2-3 weeks following surgery. Some patients, however, do not get to outpatient therapy as quickly. They may undergo home therapy or stay in a rehabilitation facility for longer periods of time. If the patient and/or therapist are not well educated on the dos and don'ts following joint replacement surgery, patient functional progress at this stage may be less than optimal.

Another determinant of successful recovery following knee surgery appears to be the quality of spousal support following surgery. For adults with chronic illness (e.g., arthritis) the spouse is most often the primary source of support during health-related difficulties. Previous research has indicated that greater spousal emotional support bolsters feelings of efficacy, which in turn increases psychological well-being.

A patient education lecture geared towards understanding arthritis and what to expect following a total joint replacement may help to resolve some of these issues. By educating the patient on arthritis and initiating a gentle exercise program prior to surgery, the patient will be taking an active role in preparing for the surgery. If they have a waiting period of 3 months, this will give them something to focus on during that time. The exercise program should be gentle enough to be tolerated easily and should address range of motion and functional limitations the patient is currently experiencing.

This education lecture will also be helpful for patients to attend prior to having surgery. By educating the patient prior to surgery, we are empowering them to be able to recognize good care as well as substandard care following their procedure.

By providing a free lecture open to the public, we are encouraging family members, as well as patients, who will be involved in the post operative care plan. This lecture, complete with a question and answer session, provides patients and family members alike a forum to ask questions, receive information and answers that may help coping with post-operative care. Issues such as transportation, frequency of exercise, intensity of exercise and what they can do at home to help the healing process often arise.

In summary, there are many factors surrounding the success of joint replacement surgery. It is my hope that by providing the community with correct and applicable information, we will be assisting in improving outcomes following surgery as well as a better quality of life for those patients living with arthritis.

STAR Physical therapy is an active member of the surrounding community. If you or your organization would like us to come speak to your community group about the benefits of exercise before or after total joint surgery, please feel free to contact us directly. We would be happy to donate our time to the local community and assist it's members in learning how to live a healthier lifestyle!

Dr. Andrea Johnson, PT, DPT, MS
STAR Physical Therapy
Clinical Director - Mt Laurel / Cherry Hill