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.