After Joint Replacement

This is not the usual opening for a page like this, and it is what the evidence says. For an uncomplicated primary hip or knee replacement, inpatient or clinic-based rehabilitation produces no clinically important advantage over a home-based programme — not for mobility, not for pain, not for function, not for range of motion, at ten weeks or at a year 1.

So if your operation went well, you are reasonably fit, and you have someone at home, the honest answer is that a good home programme with local physiotherapy is likely to get you to the same place. Flying to another country for it buys convenience and supervision, not a better knee.

We would rather tell you that than take the booking. It costs us a routine case and it saves you the flight — and the people this page is genuinely for are further down.

The group with most to gain is the one whose knee is not bending. Arthrofibrosis — scar tissue restricting the joint, usually defined as less than 90 degrees of flexion — is among the most disabling complications of knee replacement and a leading reason for readmission and revision 5. It affects tens of thousands of people a year, and around a quarter need a further operation 5.

Timing is the part most patients are never told. Where manipulation under anaesthesia is needed, doing it within twelve weeks of the original operation produced an average gain of around 36 degrees and a final range near 119 degrees; after twelve weeks the same procedure gained around 17 degrees and finished near 95 degrees 3.

If your knee is stiff and you are inside that window, this is urgent in a way that most rehabilitation is not. Send the records now rather than waiting to see whether it improves — and if the answer is that you need a surgical opinion rather than a therapy block, that is what the reply will say.

A stiff knee inside or near the manipulation window. A revision replacement, where the soft tissue and bone are compromised and progress is slower. Bilateral surgery, where there is no good leg to lean on. A complicated recovery — infection, fracture, nerve injury, prolonged non-weight-bearing.

Also: people who live alone or without anyone who can help, people who were frail before the operation, and people who are significantly behind their milestones and losing confidence. Being behind schedule with nobody to supervise you is a real reason to come, and it is not a failure.

If your situation is not on this list, say so in your enquiry and ask directly whether travelling is justified. You will get a direct answer.

For a knee replacement the usual targets are full extension and about 90 degrees of flexion by four weeks, and approaching 130 degrees by twelve weeks 4. Extension matters more than most patients realise — a knee that will not straighten fully changes the whole walking pattern and is harder to recover than flexion.

For a hip replacement the constraints are different: range is rarely the problem, and the work is strength, gait pattern, and confidence, along with any precautions your surgeon has specified for the approach used.

Measure rather than estimate. "It feels stiff" and "it is at 78 degrees at six weeks" lead to different decisions, and only one of them can be acted on.

A knee replacement is a range-of-motion problem first and a strength problem second. Time lost early is hard to recover, which is why the first six weeks carry more weight than any later period.

A hip replacement is a strength and gait problem, with precautions that depend on the surgical approach. Patients often feel better sooner and then plateau, because the limp that remains is a muscle and pattern problem rather than a pain problem — and it responds to training rather than to time.

Two to four weeks, three to five hours a day. Range of motion work where that is the constraint, progressive strengthening, gait retraining with analysis, aquatic work to load the joint earlier than land allows, and the anti-gravity treadmill where full weight-bearing is not yet possible or comfortable.

The block ends with a measured re-assessment and a home programme, and the discharge document goes to your surgeon with the numbers in it.