What is prehabilitation before knee replacement surgery?
There prehabilitation This refers to all the actions taken before a procedure to prepare the body and the patient for surgery. In the context of arthroplasty, prehabilitation before knee replacement may include physical exercises, advice on daily activities, home preparation, information on the surgical process and, when necessary, optimization of general health.
This approach does not aim to train the patient like a top athlete. Its objective is more practical: to preserve or improve the abilities that will be useful in the first few hours following the procedure. Getting up, walking with crutches, contracting the quadriceps, or bending the knee all require a minimum of strength and confidence.
Prehabilitation also allows for a better understanding of the different stages of treatment. The patient has a clearer understanding of what to expect regarding pain, mobilization, physiotherapy, and returning home. This improved anticipation can reduce some anxieties and facilitate active participation in recovery.
Why is physical fitness before surgery important?
Osteoarthritis Advanced pain often leads to a gradual decrease in activity. The pain causes people to walk less and avoid certain movements, which can lead to... loss of muscle strength and endurance.
However, while the prosthesis corrects the joint, the muscles must then regain their function. A quadriceps that is already very weak can complicate walking and the first movements after the operation.
Prehabilitation before knee replacement surgery aims to prepare the body before the operation by working on, in particular:
- Muscle strength, in particular the quadriceps
- Balance and stability
- Endurance
- Mobility and walking
The goal is to have a better "functional reserve" to facilitate the early stages of recovery.
What exercises can be done before knee replacement surgery?
Pre-habilitation before knee replacement surgery must be tailored to each patient. Exercises should not cause a sustained increase in pain or significant swelling.
It may include, in particular:
- Muscle strengthening : quadriceps primarily, but also glutes, hamstrings and calves.
- Knee mobility : preserve extension and gradually work on flexion, without forcing the joint.
- Functional exercises : simple movements adapted to the patient's abilities to maintain walking and stability.
- Moderate endurance : stationary cycling, water exercises or interval walking depending on tolerance.
The intensity depends on the pain, mobility, and level of osteoarthritis. Therefore, a person in severe pain will not follow the same program as a patient who is still active.
How long before the operation should it be started?
Ideally, prehabilitation before knee replacement begins several weeks before the installation. A period of 4 to 6 weeks It generally allows for progressive work on muscle strengthening, mobility and exercises that will be useful after the procedure.
Even when the operation is planned to happen sooner, it is still worthwhile to start. Even a few sessions before the procedure can be helpful to learn the exercises, become familiar with crutches and better understand the different stages of recovery.
The goal is not to undertake intensive training just before the operation, but to gradually prepare the knee and the entire body, respecting each patient's pain and abilities, the program can be adapted by the physiotherapist according to the condition of the knee and the time elapsed before surgery.
Preparation is not limited to muscles
Preparing for knee replacement surgery also involves general health and planning for returning home. Several factors can influence recovery:
- Food : prioritize a balanced diet that is sufficiently rich in protein to preserve muscle mass.
- Sleep : maintain as much quality sleep as possible before the procedure.
- Tobacco and general health Smoking, diabetes and certain treatments should be discussed with the medical team.
- Weight : in cases of significant overweight, gradual weight loss can sometimes be considered, without compromising nutritional status.
- Residence : clear the passageways, secure the carpets, anticipate shopping trips and place everyday items within easy reach.
- Crutches : to become familiar with their use when they are planned after the intervention.
This overall preparation is part of the prehabilitation before knee replacement : it helps to anticipate difficulties and facilitate the return home.
Learn the post-operative exercises in advance
Discovering a movement before surgery is often easier than learning it when the knee is swollen and painful. Prehabilitation allows for repetition of quadriceps contractions, ankle mobilizations, transfers, and certain breathing exercises.
The patient can also learn to distinguish between expected postoperative pain and a symptom that requires medical attention. This education should not cause undue anxiety. Its main purpose is to help patients know when to contact the healthcare team.
Understanding the objectives for the first few weeks helps avoid two opposing attitudes: remaining completely immobile for fear of injury, or wanting to progress too quickly. Recovery requires early mobilization, but also rest and a suitable progression.
Can prehabilitation prevent the need for a prosthesis?
Prehabilitation before knee replacement surgery is not primarily intended to cancel out a procedure that has already been indicated. However, in some patients, resuming an exercise program and improving strength can reduce functional limitations. The decision can then be reassessed with the surgeon, particularly if the symptoms become compatible with the desired activities.
Conversely, limited improvement does not mean the program was useless. The muscular and functional gains can remain beneficial in the postoperative period.
The need for a prosthesis is not solely determined by an X-ray. It is based on the severity of symptoms, activity limitations, and the examination., the images and the effectiveness of non-surgical treatments already tried.
A necessarily personalized program
Not all patients approach the procedure with the same abilities. Age, associated diseases, balance, hip and ankle mobility, or the presence of pain in the other knee influence the program.
An independent and athletic person can work on relatively advanced functional exercises. A frail person will sometimes prioritize learning how to get up from a chair, use their walking aids, and reduce the risk of falling.
Pre-habilitation before knee replacement surgery must therefore remain individualized. Copying a program found online, without taking into account pain or medical restrictions, may be unsuitable.
Conclusion
Preparing for a prosthesis is not limited to preoperative examinations. Prehabilitation before knee replacement surgery combines strengthening, mobility, endurance, education, and planning for the return home. It can improve certain aspects of recovery, although its effects are neither identical nor guaranteed for all patients.
The program should be tailored to the condition of the knee, the patient's level of independence, and their personal goals. The surgeon and physiotherapist remain best qualified to determine the appropriate exercises and their intensity. While proper preparation does not replace postoperative rehabilitation, it can help the patient approach it with a better understanding of the process.
