In 2017, nearly 700,000 people will choose joint replacement surgery. Nearly half will have complications. Difficulty climbing stairs, constant pain and even traumatic falls are real problems. Physical therapy, both before and after surgery, can help improve your odds for a better recovery.

Undergoing physical therapy before surgery helps your body handle the trauma and the physical changes it’s about to face. For instance, look at hip surgery. Gait disturbance, where you no longer walk with normal strides, can happen in nearly half of patience who report problems after surgery. This is often caused by weak muscles (36% percent of affected patients) or tight muscles (over 40% of affected patients). This is often known as “hip drop” and it can debilitate you.

Weak areas in the body before surgery become like dominoes that trigger new problems. For instance, post-surgical pain and edema (fluid retention) can keep you from working your quadriceps and stretching your hamstrings. This then affects the very muscles needed to stabilize the hip joint, causing further weakness and more problems in the joint itself.

Looking at knee surgery, many patients see problems triggered by tight muscles in the groin. Those patients lack the flexibility in their hip because of a tight psoas muscle and shortened quadratus lumborum muscle. A tight psoas muscle then results in piriformis syndrome, trochanteric bursitis, iliotibial band syndrome, and lateral knee pain, all dominos that fall because the body was trying to over compensate for weak areas. The result is often re-injuring your joint.

You can fix the “post surgery” problem by improving your range of motion before surgery. There is good evidence that starting physical therapy before the surgery results in very positive results after surgery. Ensuring that your body is properly conditioned before surgery improves the odds that you’ll return to activities like playing tennis, golf, bowling, speed walking, dancing, bicycle and so forth.

Want the best chance of success? Exercise and start now, before surgery. A 2003 study has shown that both home exercise and physical therapy have an equal chance at preparing patients for surgery. Both will help, and most insurance companies consider both routes in their reimbursement decisions. However, we believe that home exercise alone cheats patients of quality care. Many people do their exercises wrong.

Teaming with a therapist towards the goal of recovery is your best chance at getting your life back after joint surgery.

By Raj Issuree, MPT






Laubenthal KN, Smidt GL et al. A Quantitative analysis of knee motion during activities of daily living. Phys Ther 1072; 52(1): 34-43

Bhave A, Marker D et al. Functional problems and treatment solutions after total hip arthroplasty. J Arthoplasty 2007; 22(6): 116-124

Moutzouri M, Gleeson W et al. What is the effect of sensori-motor training on functional outcome and balance performance on patients undergoing total knee replacement? A systematic review. Physiotherapy 2016; 102(2): 136-144

Liebs TR, Herzberg W et al. Ergometer cycling after hip and knee replacement surgery: a randomized controlled trial. JBJS Am 2010; 92(4): 814-22

Winters J, Rudolph K. Quadriceps rate of force development affects gait and function in people with knee osteoarthritis. Eur J Appl Physiol 2014; 114(2): 273-284

DiMonaco M, Vallero F. Rehabilitation after total hip arthroplasty: a systematic review of controlled trials on physical exercise programs. Eur J Phys Rehabil Med 2009; 45(3): 303-17

Wallis J, Taylor N. Preoperative intervention for patients with hip and knee osteoarthritis awaiting joint replacement surgery: a systematic review and meta-analysis. Osteoarthitis and Cartillage 2011; 19(12) 1381-1395

Kramer J, Speechley M et al. Comparison of clinic and home based rehabilitation program after total knee arthroplasty. CLin Orthop Rel Res 2003; 410; 225-234

Gilbey H, Ackland T et al. Exercises improves early functional recovery after hip arthroplasty. Clin Orthop Rel Res 2003; 408; 193-200

Thomas KS, Muir KR et al. Home based exercise programme for knee pain and knee osteoarthritis: a randomized controlled trial. BMJ 2002; 325: 752

Mizner R, Petterson S et al. Preoperative quadriceps strength predicts functional ability one year after total knee arthroplasty. J Rheum 2005; 32(8): 1533-1539