Total knee and hip replacements are among the fastest growing surgeries in our country. Physical Therapy remains the first line treatment for patients with knee and hip arthritis, but in patients with severe osteoarthritic pain and loss of function joint replacement remains a good surgical option. In prior research among patients undergoing these procedures there is often a disconnect between subjective reporting of pain and function and the objective testing of a patient's function. For example, a patient may report great outcomes and an ability to walk long distances without fatigue or pain, but objective testing in Physical Therapy often reveals residual endurance, strength, and balance impairments.
In addition to severe pain, one of the most important indications for a total joint procedure is loss of function. After the surgery patients are expected to increase their activity levels due to reduced pain, but new research is questioning this assumption. A recent review article in the Journal of Orthopedic and Sports Physical Therapy examined if physical activity levels increased after these procedures (Arnold et al. 2016). Authors reviewed the available data and found 8 studies of 373 patients who underwent a total joint replacement.
These studies objectively tracked a patients physical activity levels up to 1 year after the procedure to see if levels had increased compared to pre operative levels. The authors reported negligible improvements at 6 months and limited evidence to support increases in activity levels at 1 year. At one year, patients with total joint replacements were significantly less active than their peers. This study indicates the importance of post operative Physical Therapy to effectively improve strength, endurance, and balance allowing patients to resume an active lifestyle.