How we treat recovery after joint replacement

Two people six weeks after the same operation can need entirely different work: one needs range of motion urgently, the other needs strength and gait. Goniometry, gait analysis and strength testing separate them on the first day.

If the assessment shows that a home programme would achieve the same thing, we say so — even at that point.

Where flexion or extension is behind the milestone, that is the priority and everything else is arranged around it: frequent short mobilisation sessions rather than one long one, pain control timed to sessions, and daily measurement so progress is visible in degrees rather than in impressions.

Extension is pursued as hard as flexion. It is less satisfying to work on and it matters more for walking.

Aquatic work allows walking and strengthening at a fraction of body weight, which brings loading forward for people who cannot yet tolerate it on land. The anti-gravity treadmill does the same on land with a precise percentage of body weight.

Both exist to start useful work sooner. Neither is a substitute for progressive strengthening once full weight-bearing is possible.

Many people walk badly long after the joint stops hurting, because the pattern learned while it did hurt has stuck. Gait analysis identifies what is actually happening, and retraining addresses it directly.

This is the part most often skipped, and it is the part that decides how the joint looks and feels a year later.