In the evolving era of orthopaedics, the major surgeries are turning into day care surgeries. With the advent of Minimally Invasive Surgeries, the hospital stay of the patients of joint replacement and spine surgery has gone down from the traditional 7 days, to 2-3 days.
The patient walks immediately on the next day of procedure; this is only possible with a good rehabilitation protocol. The span of time that a patient may require in rehabilitative care depends on the speed with which the patient is able to see results and success, as well as the severity of the injury.
An occupational therapist will advise you about daily life alterations, to aid maximum movement and comfort at home, workplace etc. This can include wheelchair ramps, wheelchair friendly bathrooms, etc.
The road to recovery doesn’t have to wait until after surgery. In fact, two aspects of the surgical experience critical to achieving a successful recovery are, pre and post-operative rehabilitation.
This is a structured program created by therapists prior to the surgery, so that one can have a good outcome post-surgery. The goals of a pre-habilitation program are:
- To prepare the patient mentally for the surgery
- To reduce pain and inflammation
- To restore range of motion
- To improve muscular control of the injured joint
- To normalise the movement patterns of the bone prior to the surgery
- To make one understand the exercises that they will be performing immediately after the surgery
Post an orthopaedic surgery, a physical therapy is suggested to facilitate a speedy recovery. Physical therapy can be started anywhere from a few hours to a few days, after surgery.
An overarching post-operative rehabilitation program is designed by a physical therapist, which assists in healing, reducing pain and swelling, restores joint mobility, flexibility and strength.
Physical therapists will evaluate the patient and set a goal to minimise the adverse effect of the surgery, and work towards restoring normal movement, function and flexibility.
The therapist and patient will work towards establishing the goals related to resuming day to day activities, post which, the Therapist will design an exercise program pertaining to patient’s need and abilities.
Divided into distinct phases, the 1st therapy is undertaken immediately after the surgery and 2nd is the series of exercises to restore range of motion, stability, and strength.
Post-operative treatments may specifically include:
- Pain reduction modes such as ice, heat, and electrical stimulation
- Flexibility exercises to improve range of motion and strengthening of muscles
- Step analysis and gait training
- Self-care training
- Instruction and trainings for home exercises
Consequences of not initiating rehabilitation program
Failure to initiate a timely Rehabilitation Therapy after an orthopaedic surgery adversely affects both the patient and the surgical outcome. The risks are:
- Patient is 8 times more likely to develop chronic pain
- Increased risk of Deep Vein Thrombosis (DVT), pulmonary embolism and pneumonia
- Increased risk of developing bedsores and pressure sores
- Can cause motor disability with increased pain, joint stiffness, swelling, Causalgia or Complex regional pain syndrome
- Difficulty to walk – postural and gait changes due to muscle weakness in weight bearing joints.
- Longer recovery period and longer hospital stay
The author is a Spine Surgeon, an Orthopaedist and a Joint Replacement Surgeon at Hiranandani Hospital, Vashi