We recently sat down with Dave Kempfert, PT, Director of Rehabilitation Services at the Bone and Joint Institute of Tennessee to discuss new protocols in physical therapy and rehabilitation. Find out how patients are recovering from joint replacement surgery much faster than ever before.
Q: How have the rehab protocols for total joint replacement patients improved or changed in recent years?
Kempfert: Back in the day we used to see patients for months of rehab to regain range of motion and function. Today, many patients are coming in at 2 – 3 weeks of rehab looking like they used to after four months of therapy.
Surgical technology has also improved joint replacement outcomes significantly. Doctors can use CT scans and 3D planning with robotic assistance to make very precise decisions and cuts. More precise surgery leads to less soft tissue trauma, which we love on the rehab side. This means patients generally have more mobility and less swelling and pain post-op.
Because of this, we’re able to get patients started on a lot of things sooner. We often have to hold patients back from doing too much because they feel so much better.
Q: How does the Bone and Joint Institute of Tennessee excel in providing rehab after total joint replacement?
Kempfert: I think as a team the Bone and Joint Institute of Tennessee is blessed with a lot of great providers, both physicians and rehab clinical staff. We excel, in part, because of our ability to work as a team; we’re literally down the hallway from our doctors. Our physicians are very experienced; they do about 1,400 hip and knee joint replacements per year.
Much of our success comes from working together in providing preoperative education through our total joint education classes. It’s a collaborative effort between all departments: surgery, rehab, and the groups that provide the walkers and ice machines you go home with. We give education on nutrition, safety and fall risk, and preoperative exercises to prepare patients before the surgery. We all feel better if we can help our patients become knowledgeable about what to expect. This gives the patients and family members a lot of peace of mind going into surgery and also results in better compliance after surgery.
I think we do a good job between the anesthesiologists who do pain management during surgery and the doctors who do pain management after surgery.
Physical therapy teaches people the appropriate ways to use heat and ice, electrical stimulation to block pain, proper positioning, and use of assistive devices like canes and walkers. It’s a team effort. All of us work together, and this includes the patient actively taking responsibility for their care.That really makes a difference in the great outcomes that we get here.
Q: What’s the rehab process like for total hip replacement surgery?
Kempfert: Oftentimes, we don’t see total hip patients in physical therapy. We will do physical therapy if someone is getting back to a high level of activity or has a fairly active lifestyle and the doctor and rehab team agree the patient needs it. The majority of total hip patients can often get back to a good quality of life without physical therapy.
Q: What’s the rehab process like for total knee replacement (TKR) surgery?
Kempfert: Now that’s different! You will not do well after total knee replacement – no matter how skilled your surgeon – without quality rehab services. It starts with education. A lot of times patients feel strange things after TKR. We can help them know what’s normal and how the healing process is going to work. We can help them achieve a positive mindset and motivate them to work hard and improve.
We also do a lot for pain and swelling control through ice, electrical stimulation, manual techniques, manual mobilizations to the kneecap and joint, and even help control pain through breathing techniques. Getting that thigh muscle to activate again is important. Swelling and discomfort and the apprehension after surgery can lead you to not being able to fire your thigh muscle properly. We also work on full knee extension and a good knee bend immediately after surgery.
These things aren’t worked in isolation. And there’s no “cookbook.” Some people may have a great bend, but they can’t get their knee straight, or vice versa. We can’t just give them a handout on TKR rehab; you need a skilled interventionist.
Progressively getting the patient back to weight-bearing and normalizing their gait/walking pattern is important. Then we start doing small, but progressive training steps so they get back to daily living: getting out of bed, out of chairs, negotiating stairs, etc. We teach safe ways to get up and down and make sure they’re stable.
Along with that comes balance control and balance training. You lose a sense of where your body is in space sometimes after joint replacement surgery. So you have to retrain people on what normal motion looks and feels like. We want to make sure people get a safe transition home and not fall, which we all know can lead to injury and setbacks with progress.
Finally, we get to multitasking drills. People need to train in real life situations, so we may simulate going downstairs while carrying your little dog or a laundry basket. Before we discharge a patient, we might add extra weight or challenges that throw them off balance. This helps ensure patients will be safe and not be at risk. Multitasking is an important part of getting back to a task in the real world.
We continue to change protocols as the times change. It all depends on the individual. While we’ll always push to get you to the standardized goal, there’s no exact “recipe” for recovering from a joint replacement. One person’s great function may be to walk their dog; for another, it may mean hiking hills on unstable surfaces. We try to become a true coach and partner with our patients to achieve optimal outcomes.
Schedule An Appointment for Rehabilitation Services
For more information about Rehabilitation Services, visit their website at https://bit.ly/3d5M1DY or to schedule an appointment, call (615) 791-2640.
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