Inpatient orthopaedic rehabilitation

Structured daily rehabilitation after joint replacement, fracture, spinal surgery or major orthopaedic injury: range of movement, progressive strengthening, gait retraining, and functional training for the activities you need to return to.

Sessions run two to four times daily depending on the stage and the surgery. Pain management and swelling control run alongside, because neither range nor strength progresses in a swollen, painful joint.

Weight-bearing status, range restrictions and the timeline for progression are set by the operating surgeon, and they differ between surgeons and between implants for the same operation.

We ask for the operation note and the rehabilitation protocol in writing before admission. Where a patient arrives without them we contact the surgeon rather than infer the protocol from the procedure name, because inferring it is how early failures happen.

Patients who cannot yet manage at home safely, who live alone, who have stairs they cannot negotiate, who have had complex or multiple procedures, or who have other conditions that complicate recovery.

For a straightforward single joint replacement in a fit patient with support at home, outpatient rehabilitation is usually the right answer and we will say so rather than admit them.

Joint range in degrees, strength, walking distance and speed, stair performance, and a validated functional score for the joint concerned. Recorded at admission and discharge.

For international patients the discharge report is written to be usable by a clinician in your own country, with the measurements, the protocol stage reached and what remains to be done.

The operation note, the weight-bearing status, any range-of-movement restrictions and the timeline for progressing them. These govern the first phase entirely, and a programme built without them is guesswork.

Where the surgeon is abroad we work to their written protocol and report back to them. Where a restriction is unclear we ask rather than assume, because the cost of getting it wrong falls on the repair.

Both are expected after major joint surgery and both limit what can be trained. Managing them is part of the programme rather than something to endure until therapy can start.

Swelling that increases rather than settles, calf pain, fever or a wound that changes appearance are reported the same day. These are the complications that turn a good recovery into a readmission.

It depends on the operation and on the person. After an uncomplicated knee replacement, a randomised trial of 165 patients found that ten days of inpatient rehabilitation followed by a home programme did not improve walking at 26 weeks compared with a monitored home programme alone 1.

After a hip fracture in older people the picture is different. A Cochrane review of 28 trials with 5,351 participants found moderate-certainty evidence that multidisciplinary rehabilitation in hospital probably reduces the number of people who die or have to move into a higher level of care within six to twelve months 2. An inpatient stay earns its place when the recovery itself is complex, not simply because there was an operation.