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Early rehab after knee surgery pays off

March 10th, 2011

Back in 2009, I wrote about the trend to move from passive rehabilitation to active rehabilitation — that instead of “RICE” (rest, ice, compression and elevation), we should think in terms of “MICE” (movement, ice, compression and elevation). In that light, I was interested to see a new Spanish study that tested when rehab should begin after knee replacement surgery. They took 300 patients and randomly assigned them to begin rehab either within 24 hours of surgery or 48 to 72 hours after surgery. The results were clear:

On average, those beginning treatment earlier stayed in hospital two days less than the control group and had five fewer rehabilitation sessions before they were discharged. An early start also lead to less pain, a greater range of joint motion both in leg flexion and extension, improved muscle strength and higher scores in tests for gait and balance.

Obviously they weren’t doing jumping jacks or anything like that on day one:

The post-operative treatment began with a series of leg exercises, breathing exercises, and tips on posture. By the second day walking short distances with walking aids was added, and in subsequent days this was built up towards adapting to daily life activities, such as beginning to climb stairs on day four.

Anyway, just thought it was an interesting data point — that even for something as major as a knee replacement, lying around and staying immobilized is no longer seen as the optimal way to promote healing.

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  1. March 10th, 2011 at 15:24 | #1

    This is something I’ve learned from personal experience with running injuries. It’s always best to cross-train or run lightly (if possible) than complete rest. Movement enhances mobility and the blood flow speeds healing. Great to see that the science is finally catching up to experience!

  2. March 12th, 2011 at 01:13 | #2

    Not to take away from the study, but this is currently being done in Canadian hospitals and has been for several years. Many surgeons look to discharge the majority of patients within 4 days (included in this is the ability to ascend and descend stairs) and the vast majority are certainly walking with aids (10 to 20 feet) within a day. Physios routinely visit or have the patients wheeled to the physio room for ambulation training within the first 24 hours. Bed mobility is always taught immediately post op.

    Greg Lehman
    p.s. Alex it turns out our wives know each other, your wife beat a City of Toronto track record of my wife’s many years ago.

  3. alex
    March 12th, 2011 at 03:52 | #3

    Ha! Interesting connection. Now I’m trying to guess who your wife is!

    Speaking of my wife, they do the same thing (early mobilization) after knee replacement surgeries in the hospital where she’s studying here in Australia, starting with range-of-motion movements immediately after surgery. The idea of early mobilization seems to be pretty standard in the medical world, but still runs counter to the intuition most of us outside that world start with, I think.

  4. Sherie
    April 11th, 2011 at 22:48 | #4

    I just had
    knee replacement surgery in March, and I think any surgeons that are current with the times are definitely using modern techniques for after care. I think the quicker you can get moving, the quicker you can start healing. I was up the first day, not weight bearing (obviously) but still working hard on just getting up in general. I think you can recover in 3 weeks from this if you try!

    -Sherie

  5. alex
    April 11th, 2011 at 23:20 | #5

    Thanks for the comment, Sherie. Definitely agree that surgeons already know this — I’ve heard from a few doctors saying “Of course! We’ve been doing this for years!” I think it’s one of those things that hasn’t fully penetrated to the general population: most people still assume that the more you rest up and stay immobile after an injury, the better. Anyway, glad to hear your recovery is going well, and best of luck with the rest of the rehab!

  1. March 10th, 2011 at 16:04 | #1