An article that surfaces peer-reviewed research related to orthopedic surgery recovery for patients.
The road to orthopedic surgery recovery can be long, ranging from a few weeks to several months, with many obstacles along the way. But that doesn’t mean it has to be complicated for your patients. Even though orthopedic surgeons are less directly involved in rehabilitation, you still play a fundamental role in your patients’ recovery post-surgery. Whether you’re helping patients get as healthy as possible before the procedure or referring them to physical therapy for postoperative care, your decisions help them get back to baseline quickly — or even surpass it entirely.
By applying some best practices before and after operating, you will help your patients recover from orthopedic surgery more quickly, resulting in greater patient satisfaction and better outcomes overall. Faster orthopedic surgery recovery reduces the likelihood of multiple interventions, so you can focus on helping your patients reach long-term recovery goals like regaining strength or returning to regular sports practice.
Encourage early mobilization after surgery
Early mobilization is a key component of enhanced recovery after surgery (ERAS), a set of global standardized best practices applied before, during, and after surgery to reduce recovery time. ERAS aims to improve patient outcomes while controlling costs and reducing readmission rates after surgery.
A 2015 study of patients recovering from joint replacement surgery of the hip or knee in an acute hospital setting found that early mobilization can reduce the length of stay by about 1.8 days. Individual trials also reported improvements in muscle strength and lower limb range of motion. Another study of total knee arthroplasty patients found that early mobilization led to a better chance of “achieving 90 degrees of knee flexion" and a lower likelihood of requiring a walking aid with a large base, like a walker instead of a straight cane.
According to a 2022 study published in The Journal of Comparable Effectiveness Research, early mobilization empowers patients to recover their functional walking capacity more quickly. Patients no longer rely on nurses or other healthcare professionals to help them with simple tasks, which reduces their length of stay and care costs after surgery. Recovering their independence enables patients to return home and start postoperative rehabilitation as soon as possible, rather than letting the muscles atrophy.
Although patients need adequate rest after surgery, not moving enough could increase the risk of complications like deep vein thrombosis (blood clots that may result from immobility and poor circulation after surgery). Additionally, prolonged bed rest can result in neuromuscular weakness, causing catabolism and muscle atrophy, as reported in a 2013 study on early mobilization in the intensive care unit.
Based on current ERAS protocols, you should recommend physical therapy as early as two to six hours after surgery if the patient is stable enough. Moving early after surgery doesn’t require any complicated exercises. A 2019 analysis of early mobilization after total knee arthroplasty evaluated the benefit of simple weight-bearing activities, like getting out of bed, walking short distances, and climbing stairs until patients can move independently. The study found that over 70% of patients who mobilized on postoperative day 0 (POD 0) were discharged home instead of to a subacute rehabilitation facility, compared to only 58% of patients who mobilized the day after surgery.
A physical therapist can also demonstrate exercises to give the patient a solid foundation for rehabilitation. For instance, passive stretching can preserve muscle architecture by decreasing muscle fiber atrophy and protein loss, according to a 1995 study of critically ill patients.
Early mobilization should ramp up after the first postoperative day after surgery. A 2015 trial in Munich, Germany, measured the effectiveness of a full weight-bearing mobilization and strength training plan on the third day after a total hip replacement. Not only did patients tolerate this daily intensive training well, but they also achieved significantly better results in hip flexion, extension, and abduction mobility.
Advise your patients to follow a specific diet before and after surgery
A healthy diet before and after surgery can help your patients boost their immunity and regain bone strength for optimal recovery. The best surgery and physical therapy can only do so much if patients don’t get enough nutrients from their diet. Fasting 24 hours before surgery to avoid regurgitation or aspiration under anesthesia is no longer a best practice. According to a 2019 meta-analysis of orthopedic ERAS programs, malnutrition before surgery can actually lead to wound infection at the surgical site and delayed healing, prolonging a patient’s recovery or requiring intervention.
A 2020 study of elective ambulatory surgery patients found that patients can safely load up on carbohydrates by consuming a clear carbohydrate-rich drink two hours before surgery. Preoperative glucose intake can reduce insulin resistance by up to 50%, which improves a patient’s stress response to support optimal recovery. If left uncontrolled, insulin resistance can impair the patient’s immune system, increasing the risk of infection and even death.
Dr. Kevin Stone of the Stone Clinic in San Francisco, Calif., recommends a high-protein diet after orthopedic surgery: “It’s protein that builds muscle and provides the longest lasting energy supply, it helps the immune system resist infection ... and it also allows bones to build mass and helps your tissues repair.” You should also recommend essential amino acid supplementation, which a 2018 study of total knee arthroplasty patients found significantly reduces muscle atrophy. Essential amino acids have been shown to enhance functional outcomes like maintaining get-up-and-go times and improving stair climb times.
Collaborate directly with your anesthesiologist
A successful recovery after orthopedic surgery is an extensive process that involves a team of healthcare professionals. Of course, this includes physical therapists, occupational therapists, nurses, and dietitians. But don’t forget an important partner during the surgical procedure itself: the anesthesiologist. An anesthesiologist will help you determine the best methods for early mobilization and postoperative pain management.
The anesthesiologist will review the patient’s case and medical history to decide how to use anesthetics during and after surgery. Confer with the anesthesiologist before and after the procedure to understand how their anesthetic techniques and your patient’s underlying health conditions will affect their recovery. This will inform your recovery recommendations, like how soon to start moving after the procedure and how to identify abnormal pain.
The right anesthetic technique will enable patients to avoid postoperative complications and get an earlier start on rehabilitation. A 2016 meta-analysis from the Mayo Clinic College of Medicine and Science found that neuraxial anesthesia was associated with a reduced risk of deep vein thrombosis and pulmonary embolism. In a 2018 study of total hip and knee replacement surgery patients, unilateral selective spinal anesthesia enabled patients to bear weight on the same day of surgery and start physical therapy the day after.
Today, anesthesiologists typically use a multimodal approach to pain management, which combines regional techniques, like epidural and peripheral nerve blocks, with patient-controlled analgesia (PCA) pumps for pain relief. This form of pain management can lower or even eliminate a patient’s reliance on opioids during orthopedic surgery recovery. This reduces unpleasant side effects from pain medication, like nausea, vomiting, sedation, and dizziness, as reported in a 2015 study from Weill Cornell Medical College. Additionally, avoiding prolonged opioid use can reduce the risk of long-term addiction.
Monitor patients remotely between appointments
Every day is different during the orthopedic surgery recovery process. A patient might see consistent progress for a week, but just one day could set back their strength or mobility. As outpatient procedures become more common, many orthopedic surgeons find themselves unable to see how their patients are doing after surgery. However, by remotely monitoring patients during their recovery, you can more quickly determine if they are progressing as expected or if they require another intervention.
Remote therapeutic monitoring has emerged as a powerful tool for gaining insight into orthopedic surgery recovery. Because remote therapeutic monitoring collects non-physiological data, you don’t need to use medical devices to take measurements, making it easy and cost-effective to implement. Instead, you ask patients to self-report data like pain levels and range of motion, which helps you identify possible complications like muscle atrophy.
Newer software like Exer Health makes the process of gathering and analyzing remote therapeutic monitoring data even simpler. With just a smartphone camera, our AI-powered app precisely measures patient performance like range of motion so you’re no longer left wondering how they’re doing after surgery. With this data, you will more accurately evaluate your patients’ progress over time instead of waiting for follow-up appointments.
If you notice that a patient isn’t recovering as you might expect, you can intervene before it’s too late. This could mean the difference between a slight adjustment in their recovery plan, extending their recovery by a few weeks, or another surgical intervention in the next year. It’s better to know if your patient is healing well sooner rather than later so you can avoid additional procedures that will prolong their recovery time.
Improve the orthopedic surgery recovery process by taking the right steps before and after operating
Although orthopedic surgery itself has become faster in recent years, recovery will never be a short process. But with the right approach, you can help your patients minimize complications to reduce their recovery period.
What you do before surgery matters just as much as your postoperative protocols. To set your patients up for success, host a preoperative patient education program about preparing for and recovering from surgery. This might cover topics like how to modify the patient’s home so they can easily move around without injuring themselves and how and when to use certain products, like assistive walking devices. Ultimately, a supportive orthopedic care team and a push toward independence will speed up your patients’ orthopedic surgery recovery and improve patient outcomes.
Photo by Conscious Design
