Q: I lost my job two days before a scheduled total knee replacement. I decided to go ahead with the surgery anyway. I was forced by the lack of health insurance to get up and get going right away. I'm here to report to everyone else what a difference that made! My physiotherapist said I regained more knee motion faster than anyone else she has ever had. Likewise for pain relief: I set my mind to get up and get going. I did and it worked. Please pass this on to your readers. Thanks.

A: Your experience is very similar to patients in a recent study from Spain. Surgeons in Spain evaluated 306 patients with knee osteoarthritis receiving a knee replacement. Two groups of patients were compared. The first group received physiotherapy and started a rehab program within 24 hours of the knee replacement surgery. The second group (with an equal number of patients) began the same rehab program 48 to 72 hours after the replacement procedure.

Patients in both groups were treated in the same hospital by the same physiotherapist following the same exercise program. The therapist used a mobilization program, exercises, breathing, and posture instruction. The program was advanced as quickly as possible based on each patient's performance and tolerance.

Outcomes were measured in terms of knee motion, level of pain, and muscle strength (quadriceps muscles along the front of the thigh and hamstring muscles along the back of the thigh). Function was also assessed using activities of daily living, balance, and walking as the benchmarks.

Patients who started therapy right away stayed in the hospital (on average) of two fewer days compared to the group who received delayed physiotherapy. The early group also got their balance and normal walking pattern back faster compared with the group who started rehab later.

According to this study, getting patients up and moving after total knee replacement is the best medicine. The longer the delays and the more days in the hospital, the slower the recovery and the greater the costs associated with the procedure. Physiotherapy to initiate therapy as early as possible is recommended -- both for the patient's benefit and for a cost-savings measure.

Congratulations! Your experience certainly sounds like it mimicked what was reported in this study. Not everyone can do this but for those who can, it is well worth the effort!

Reference: Labraca NS, et al. Starting Rehabilitation Within 24 Hours After Total Knee Arthroplasty Was Better Than Delaying to Within 48 to 72 Hours. In The Journal of Bone and Joint Surgery. February 15, 2012. Vol. 94-A. No. 4. Pp. 366.

Kitchener Physiotherapy & Wellness provides services for physiotherapy in Kitchener.