Dr. Richard Steinfeld offers a unique service to his joint replacement surgery patients. Following surgery, each joint replacement patient will have a dedicated medical staff member from the practice visit them at their house during their recovery to ensure all of their post-operative medical needs are attended to. Our Patient Care Liaison, Nicki Harrelson, MA, has greater than 20 years of experience caring for post-op joint replacement patients.
In addition, a dedicated phone number is supplied to the patient to contact the staff member directly at any time during their recovery period. This gives the patient direct access to the surgeon in time of need. Our joint replacement patients can now be reassured of their progress, have their questions/concerns addressed directly, avoid confusion or misinformation during their recovery, and potentially avoid unnecessary ER or Urgent Care visits. The Orthopaedic Center of Vero Beach is proud to offer this unique service to our joint replacement patients.
Total hip replacement is heralded as one of the best man-made operations ever. A different method of performing this surgical procedure appears to have additional significant benefits for patients. The Direct Anterior Approach allows for a true muscle-sparing method.
No muscles are cut or removed from their bony attachments.
This has resulted in less pain, easier ability to ambulate immediately following the surgery, shorter time in the hospital, and a more rapid recovery. In fact, recovery milestones such as discontinuing a walking aid and walking distances have been noted to occur earlier in the post-operative period. It has also been demonstrated that a patient’s quality of gait returns at an earlier time than with other methods of performing this surgery.
Our patients time in the hospital is now reduced to 1-2 days. In appropriate patients this procedure can be performed in an outpatient setting as well. In short, the Direct Anterior Approach can provide a shorter time to reach functional milestones and a shorter time to recovery.
To maintain the health of the joint and keep your ROM (Range of Motion) you should continue with the exercises for a year.
Following surgery, bones, muscles and soft tissues undergo a period of healing. Failure to use the joint may cause it to heal improperly. This can limit range of motion, flexibility, function of the joint and overall surgical outcome. This makes it essential to complete physical therapy after surgery.
After surgery you can expect to have pain, swelling and inflammation. You will also be expected to begin physical therapy the day of or day after your surgery. Each day and week to follow you will find some things will be easier and some things are still difficult. You will be expected to perform your home exercise program (HEP) on a daily basis, sometimes twice daily. Progressing from home health therapy to outpatient therapy then to independence your exercises will change. Once you are discharged from outpatient physical therapy you will be given a final HEP to continue on your own. These exercises will be determined by your physical therapist to focus on the areas of weakness and to maintain proper function as you heal.
Your body’s healing process will continue for about a year after your surgery and it is highly advised to continue with your HEP during that time. If you start other activities such as golfing, tennis or going to the gym you are expected to continue with the HEP you physical therapist gave you. These exercises are specific for your injury and will focus on the areas that will help you in the healing process.
So the answer to the question . . .
How long after surgery should I continue with my exercises?
It is about 1 year after your surgery.
This year the American Physical Therapy Association has chosen the campaign #ChoosePt to aid in the reduction and use of opioids for pain management.
How can physical therapy help you with your pain management rather than the use of pain medicine?
At the Orthopaedic Center of Vero Beach Physical Therapy Department, our main purpose is to return you back to function. Your goals are established by you and your physical therapist and we teach you to manage your symptoms. Managing your symptoms means keeping pain at a minimum and preventing it from getting worse.
We start with posture and body mechanics. If you perform your exercise with poor posture your body will remain in dysfunction, also if you ignore proper body mechanics you will undo all the work of your exercises.
In physical therapy we frequently correct your posture throughout your treatment so you can feel how the exercise should be performed. We discuss how your symptoms affect your daily living and instruct you on proper body mechanics from simply getting out of bed to playing golf.
Exercises are not all about building muscle bulk but more about muscle control. When it comes to pain, stabilization is key. No matter which joint you have injured, from your wrist to your back, if there is instability there will be pain. Our physical therapists will focus on specific muscle groups and create an exercise plan specifically for you to improve your quality of life.
In addition to your strengthening program, flexibility is important to maintain movement and joint health. Muscles need to be able to move easily through their full range of motion to maintain optimal health.
Physical therapy is for life. The important thing to remember is that your maintenance program is an ongoing process. There isn’t just one thing, it’s a combination of all things to improve your health. Daily exercises and strengthening is important to feel your best and prevent further injury.
The reverse total shoulder is a specially designed type of total shoulder replacement in which the position of the ball and socket joint of the normal shoulder is switched or reversed so that the ball sits where the socket was and the socket is placed where the ball was previously located. The replacement is comprised of three main components – the humeral stem which is a piece of metal which rests in the arm bone similar to the stem of a total hip replacement. The second component is called the glenosphere. This is the ball component of the reverse total shoulder replacement and it is placed where the socket was located. The socket of the shoulder is called the glenoid. The glenosphere baseplate is fixed to the glenoid bone with special screws to ensure that it is stable. The glenosphere ball is then attached to the baseplate and secured with a special locking screw. In between the glenosphere and the humeral stem lies the polyethylene plastic insert. This component allows smooth motion in between the humeral stem and glenosphere.
There are various reasons to perform a reverse total shoulder instead of a standard total shoulder replacement. One main indication to perform a reverse total shoulder replacement is advanced shoulder arthritis in a patient with a massive rotator cuff tear which is not repairable. Standard total shoulder replacement is not appropriate in this scenario because the outcome of this surgery relies on an intact rotator cuff to function properly. Conversely, the design of a reverse total shoulder accommodates for the lack of rotator cuff function. It allows the patient to move their arm and regain function by relying on the deltoid muscle instead of the rotator cuff to move the arm and shoulder. Other reasons to perform a reverse total shoulder include a severe fracture of the shoulder or a fracture dislocation of the shoulder. A reverse total shoulder can also be used as a salvage procedure for failed total shoulder replacement because of implant loosening, rotator cuff tear or fracture around the implants.
The surgery is routinely performed under general anesthesia meaning the patient is put to sleep and intubated. A supplemental injection of local anesthetic placed around the main nerve collection of the arm called the brachial plexus is routinely used as well. This injection, called a scalene block, provides anesthesia to the entire arm for up to 12 hours after the surgery. Patients spend one night in the hospital and are discharged home the next day with a protective arm sling. Patients may shower at home and begin simple passive motion exercises to initiate the rehabilitation process. Patients are then seen in the office two weeks after surgery for staple removal from the incision and a post-operative X-ray to check the position of the shoulder replacement. Patients are then referred to supervised physical therapy where they begin more aggressive exercises for range of motion and strengthening of the shoulder. Full recovery from this surgery is typically in the range of three to six months.