I think most patients are surprised how quickly we get them up and mobilize them. It used
to be that patients would lay in bed a period of time after surgery and wait for them to
heal before they started to get up and exert themselves, when in fact we really encourage
early mobility to prevent complications from the surgery.
Physical therapy’s one of the most critical resources a patient has following their surgery
for hip or knee replacement. We’re the ones who really (after that initial surgery) get
the patients up for the first time. We re-teach them how to walk using gate devices, such
as a walker or a cane. In most cases, it’s a walker. We teach them how to get in and
out of bed. We teach them how to do all those things they need to get back to the life that
they had before, without the pain that they had.
Patients who have surgery at The Nebraska Medical Center can expect to have physical
therapy the morning after surgery. That’s when they’ll have their first session, and
they’ll have two sessions of therapy a day. That first session, we aim to get the patient
out of bed and increase their sitting tolerance so that they get used to being upright again.
They’ve been laying flat for a period of time from the surgery. We have them sit up
for a half hour to an hour if everything’s going ok the first morning. Then we’ll come
back again in the afternoon and that’s when we’ll start working on exercises and walking.
The exercises that we generally start working with are bed exercises, so patients can lay
in their bed, make sure they have pain medication before we start. Then for a knee replacement,
we’d work on knee range of motion and strengthening. For hip replacement, we work more on stability
and strengthening. As soon as we can after that, we get the patient up and walking. We
usually try to walk twenty to fifty feet the first day and progress the patients from there.
Every patient is a little bit different and sometimes patients get out of bed that first
time and feel incredibly better because most arthritic pain is gone; it’s just incision
pain. Other patients find it more challenging because they’re limited as far as how much
weight baring they can put through their leg. They feel a little bit de-conditioned or tired
from the anesthesia. But we treat every patient as an individual, so we’re making sure we’re
doing the things that they need to get back home.
We’ll teach patients better exercises if those get to be too easy for them; we’ll
progress them to seated and standing exercises. We’ll also teach patients how to go up and
down stairs, especially if they’re going home and need to access that. We have a modified
car that we practice getting in and out of a car with patients to, especially the hip
replacement patients. Occupational therapists usually teach patients how to get in and out
of the bath tub or shower.
We encourage family members to be present and participate in a patient’s recovery
after surgery. The more that they hear information from the staff members, not only the therapists,
but also the other staff members, the easier and the more comfortable it is for when they
go home. Especially if the patient has a hip replacement, there are some hip precautions
that patients will need to follow for a period of time. We like the caregivers to be able
to reinforce those when patients go home. Family members are good coaches, so once the
patients go home, whether they have home health physical therapy or outpatient physical therapy
after the fact, they may have it, they may not. Family members, often times, become the
coaches and encourage patients to continue their exercises at home so that they have
the best recovery possible.
The nice thing about the team approach at The Nebraska Medical Center is that we’re
in constant contact with the nurses and the doctors and sometimes the pharmacists and
the occupational therapists, so that we can really address the entire patient. We can
communicate with the physicians if the patients need more pain medication in order to tolerate
activity. We can really tailor patients’ exercise programs and their activity to the
things that they used to do before surgery so that they can get back to those activities.
So it’s a really individualized approach.