Hip and knee replacement physiotherapy is important!  Choosing to have a hip or knee replacement is a commitment to your health, wellness, and enjoyment of life.  Living a full and pain free life is in your future and Physio In Motion is here to help you achieve your goals.   A joint replacement is a major surgery and physiotherapy is going to be very important to ensure the best possible outcome.  As you start your joint replacement journey thank you for considering Physio In Motion as a trusted member of your healthcare team.  We look forward to the opportunity to provide you with convenient and professional physiotherapy in your home.

Accessing a Hip or Knee Replacement in Ontario

When hip or knee pain and dysfunction begins to limit your participation and enjoyment of life it’s time to do something about it.  If you haven’t already done so, schedule an appointment with your family physician to discuss your options.  You may wish to start with conservative management such as changes to your diet and weight control.  For knee pain, knee braces that unload the knee provide immediate relief and have been very effective for our clients.  Knee braces for arthritis are light and comfortable and will allow you to increase your activity levels without pain.  If you have extended health benefits your knee braces may be fully covered by your insurance.

 

When conservative management of your hip pain or knee pain is not enough it’s time to start thinking about a hip replacement or knee replacement.  In Ontario, each Local Health Integration Network (LHIN) has a Joint Assessment Centre to provide quick access to consultations and surgery for patients suffering from hip and knee arthritis.  To schedule an assessment you require your family physician’s referral to the assessment centre available within your LHIN.   When you attend you attend your appointment at the Joint Assessment Centre an Advanced Practice Practitioner (APP) will complete a comprehensive musculoskeletal assessment with you.  If it is determined that you would benefit from an orthopaedic surgery consultation you will be given the choice to see your preferred surgeon or the next available surgeon.  If the APP determines that you are not ready for surgery or if surgery is deemed to be unnecessary they will recommend a more conservative plan of care.

Surgery is Recommended, Now What?

Congratulations, you’re well on your way to eliminating your hip pain or knee pain but there is still a lot more information you need to know.  The Joint Assessment Centre has recommended a consultation with an orthopaedic surgeon and you may already have that consultation appointment booked.  Now is the time to start building muscle strength before your surgery.  Building strength before your surgery will help you recover after your surgery.  You may wish to attend a community gym or pool, enjoy daily walks, or contact a physiotherapist to help you.

Once you have seen the orthopaedic surgeon and have been scheduled for surgery you have more work to do.  Your hospital will ask you to attend a Hip and Knee Replacement Education Class to help you prepare for your surgery.  This class will provide you with information about your hospital stay and what to expect following your surgery.  Prior to COVID-19 these classes were an in-person group format but have now been replaced with online classes and/or videos.  You will also be provided with a booklet with LOTS of useful information about your new hip or knee.  Click here to see hip and knee replacement resources available from Hamilton Health Sciences.  Your local hospital will have similar resources available on their website.

Hip Replacement Surgery (Total Hip Arthroplasty)

The human hip is a one of the largest, weight bearing joints in the body.  As we age conditions such as osteoarthritis or rheumatoid arthritis can damage the smooth cartilage that allow this ball and socket joint to move freely.  The hip joint can also be damaged by trauma such as a motor vehicle accident that may result in a fracture or damage to the cartilage.  When conservative treatments such as weight loss, physiotherapy, or bracing are not sufficient to relieve pain and improve function a hip replacement might be recommended.  During a hip replacement or hip arthroplasty surgery the surgeon replaces the damaged hip joint and replaces it with an artificial (prosthetic) joint made of metal and other materials such as hard plastics and ceramic.  These materials are cemented to existing bones or are porous and the bone grows into the artificial joint components as you heal.

Hip replacement surgery is approached in a couple of different ways.  Traditionally, the surgeon makes a large incision over the hip to expose the joint.  Some muscles and ligaments must be cut to allow access to the joint which can increase the recovery time for the patient.  Hip replacement can also be completed using minimally invasive techniques that require a smaller incision(s) and cause less disruption to the muscles and ligaments which may help you heal and return to activity faster.  Minimally invasive surgery requires specialized training and equipment and may not be available in all areas of the province.  Furthermore, not every patient is a candidate for minimally invasive surgery.  Your surgeon will discuss the options and the risks and benefits of each option with you prior to your surgery.

Knee Replacement Surgery

The human knee is a large, weight bearing, joint that is greatly impacted by conditions such as osteoarthritis or rheumatoid arthritis and also by injury, activity, and our body weight.  As we age these factors begin to degrade the cartilage that cushions the joint and allows it to move freely.  The knee responds well to conservative treatments such as weight loss and bracing that unloads the joint but at some point this may become insufficient to address pain and dysfunction.  When you reach this point knee replacement surgery may be recommended.

There are two types of knee replacement surgery.  The partial knee replacement and the total knee replacement.  Partial knee replacements can address damage to the knee that is limited to only one side (the inner or outer side).  A partial knee replacement can be completed through a smaller incision which may speed healing and recovery time but they are not an option for many patients.  Partial knee replacements are also more likely to require revision (or another surgery) down the road than total knee replacements.

 

During a knee replacement surgery the damaged ends of the upper and lower leg bones that meet at the knee are capped with artificial surfaces made of metal and plastics.  These artificial materials are typically cemented to the bone by the surgeon.  Your surgeon will discuss the options with you and answer any questions you have about partial vs. total knee replacement surgery.

Physiotherapy after a Hip or Knee Replacement

A hip or knee replacement is major surgery with a significant period of healing and recovery required.  Hip and knee replacement physiotherapy after your surgery will be recommended to ensure the best possible recovery and long term outcome.  The Ontario Ministry of Health and Long-Term Care (MOHLTC) implemented a funding model for joint replacement surgeries referred to as “Bundled Care”.  Under this model the MOHLTC provides the hospital with a “bundle” of funding for each patient to cover the cost of the surgery, the hospital stay, and physiotherapy after the surgery.  The portion of funding allocated to physiotherapy after your surgery is $312.00 and your hospital is obligated to provide you with a fully funded physiotherapy option.  The fully funded option typically involves eight group exercise classes at a community physiotherapy clinic the hospital has entered into an agreement with.   If you prefer to pay privately for physiotherapy or use extended health benefits instead of funding from the Bundled Care you are free to do that as well.

Alternatively, you may choose partially private-paid physiotherapy with a provider who is registered to provide care within the Bundled Care model such as Physio In Motion.  In this scenario $312.00 of your physiotherapy is paid by the hospital under the Bundled Care model and the balance is paid privately by the patient or their extended health insurance (or both).

If you would prefer one-on-one hip and knee replacement physiotherapy in the convenience of your home while still accessing the funding available from the MOHLTC Physio In Motion is available to help you.  Please contact Physio In Motion and speak with our intake coordinator Maureen BEFORE your surgery.   Physio In Motion will confirm with the hospital that your physiotherapy will be partially funded by the Bundled Care model and advise the hospital that you have elected to participate in partially private-paid in-home physiotherapy with Physio In Motion.  Please be prepared to provide the hospital with the date of your first physiotherapy visit if asked.