Another one that's too long to post on Facebook's ASA group
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Exercise to build strength after hip, knee replacement
Long-term rehabilitation program seen as key to recovery
By Gunnar Mossberg

Tuesday, March 1, 2011

Total knee and total hip replacement surgeries have been shown to be
among the most successful of all orthopedic surgeries performed
today. However, several studies have shown that patients remain
considerably weaker in the leg that has undergone the operation,
compared with the leg that has not, which can negatively affect their
function during daily activities.

One recent study showed that one year after total hip replacement
surgery, muscles in the operated hip were 11% to 16% weaker than in
the nonoperated hip in men, and 19% to 215 weaker in women. Another
study showed significant residual muscle weakness in the operated hip
up to two years following surgery.

Following knee replacement surgery, several researchers have reported
21% to 42% quadriceps weakness as compared to the nonoperated leg at
three to six months after surgery, with a remaining 12% to 29%
weakness at one to two years after surgery. Yet another study, out of
Finland, revealed remaining significant leg weakness and atrophy, and
loss of muscle power, an average of 10 months following total knee
replacement. The researchers, along with other authors, proposed that
a knee extension power deficit can be associated with an increased
risk of falling.

Single leg balance also has been found to be significantly impaired on
the operated leg one year following hip replacement surgery. Lack of
leg muscle strength and power has also been associated with active
mobility limitations, including the speed by which a person can
negotiate stairs, and “get up and go” from a sitting position.

It is quite common for patients to have physical therapy and perform
exercise during the acute phase of rehabilitation, but more advanced
programs for the long term are often lacking. This is particularly
true following total hip replacement surgery. Therefore, many
rehabilitation programs are not progressed sufficiently to result in
significant enough strength gains. It should be remembered that many
people go into the surgery already weakened due to prolonged pain and
inactivity.

A comprehensive rehabilitation exercise program can address
neuromuscular qualities such as coordination and proprioception
(position sense), balance, endurance, strength and power. Such
functional exercise can effectively and safely be prescribed to
patients following joint replacement surgery, to restore normal
function required for daily activities. Such training can greatly
reduce a person’s risk of falling and sustaining a potentially serious
injury such as hip fracture.

It is also beneficial for people to continue with an equally specific
home rehabilitation program, to be performed for up to a year (or more
if desired). People who have the desire to return to an active
lifestyle and enjoy improved quality of life can do very well with
this rehabilitation approach. Even if weakness remains from a surgery
performed several years ago, such an exercise approach can still yield
good results.

Gunnar Mossberg, PT, MOMT, DPT, has practiced physical therapy in
Southern California since 1982. He can be reached at
[email protected]