Treating Clients with Joint Replacement

Aug 28, 2019
7 min read
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Joint replacement surgery can help clients return to occupations that caused them a great deal of pain for many months or years. Although recovering from a joint replacement is a very rewarding journey, it is not an easy one. Occupational therapists can provide some suggestions for activity modifications and home adaptations to help make the recovery process a little less daunting.

Recovery after joint replacement surgery

The recovery process begins on the day of the client’s surgery. Clients may be surprised when an occupational and/or physical therapist comes to assess mobility and strength shortly after they wake from anesthesia. It is no secret that acute care stays are becoming shorter. Therefore, every moment counts when providing OT in acute care. It is important to obtain as much information as possible about the client’s environment when completing their occupational profile. Clients may also need a gentle warning of the challenges that are to come. Unfortunately, pain is to be expected. The day of the surgery, clients may not feel much pain because of the anesthesia and medications.

However, for a period of time after the surgery (approximately 3 months), the operated limb will be heavy, swollen, and sore. Many people are surprised by this. Clients may need to be reminded to keep track of their pain medication schedule, and to avoid staying in the same position (e.g., in bed or a chair) for long periods of time to avoid stiffness. At the same time, it is important to encourage clients that this discomfort will not last forever, and that they will be able to participate in their important occupations with ease after recovery.

What is the OT's role post-surgery?

Next sessions can then be focused on helping clients complete their typical occupations, with a focus on home set-up. The home is the place where many important occupations are performed, and the set-up of the home can make a big difference in the ease at which our occupations are completed. Upon entering the home, does the client have stairs? Physical therapists usually prepare clients for their stairs, but it is within the occupational therapy scope of practice to offer safety tips! Keeping one walker downstairs and another one upstairs is helpful if possible. If no handrail is available, a cane may be helpful for use on the stairs. Having a family member assist or supervise the client their first time ascending stairs at home is recommended.

While teaching the client how to use adaptive equipment for ADLs (reachers, sock-aids, long sponges, etc.), the occupational therapist can educate the client on appropriate bathroom set-up. For example, after surgery, clients typically use a walker when discharged from the hospital. Will the walker fit in their bathroom at home? If not, what will the client hold onto for safety? Also, low commodes can be a challenge, especially for clients with hip precautions. Toilet risers can be helpful, especially those with armrests. If a riser is not an option, maybe the client has a (sturdy) vanity that they can use to push from during a toilet transfer.

When using the toilet, have the client pull their pants down to just above the knee to prevent the pants from falling all the way to the ground, in case the reacher is not handy (although reachers can be fastened to the walker with Velcro just in case). As a side note, many clients are discharged with compression stockings, which are difficult to manage! When possible, it is beneficial to have a family member assist with these. If no family member is available, a dressing stick can be helpful for doffing, and a rigid sock-aid can be used to don.

Bathing is another important ADL that often poses challenges after joint replacement. Many clients have step-over bathtubs. Although these may make for more difficult transfers than walk-in showers, occupational therapists can offer suggestions to make the transfer as easy as possible. Having a grab bar to hold onto when stepping into the tub is important. If a client has hip precautions (no bending at the hip past 90 degrees, no rotation, no crossing the leg, and no adduction of the leg), they should step into the tub by holding onto the grab bar and bending at the knee (Radomski & Trombly Latham, 2014).

Shower seats are also recommended for safety as well as energy conservation. If a client is interested in using a transfer tub bench, he should have shower curtains instead of shower doors (the bench will prevent closing the shower doors). Have the client tuck the entire shower curtain into the tub around the bench. There may be a pocket in the bench that the remainder of the curtain can also be tucked into. If not, the client can sit on this part of the curtain to prevent water from dripping onto the floor. Additionally, Handheld shower heads can give the client more control over where the water lands, thereby increasing safety.

Helping your patient adapt after joint replacement surgery

When the client is finished with ADLs, they may be ready to go back to bed! Clothing can be draped over the front of the walker for ease of transport to/from the closet. Is the client’s bed at home high or low? The hospital bed can be raised or lowered to simulate the home. Perhaps the client would benefit from a leg lifter for getting into bed if the operated limb is still heavy. The client can also be taught to use a sheet looped around the foot as a makeshift leg lifter. Some clients tend to rely on the hospital bed rails, but these may not be available at home. The client should practice getting in and out of bed without the rails. If necessary, the occupational therapist can recommend purchasing or obtaining a bed cane.

While not always a priority in the acute care setting, IADLs are important to address as well. Prior to the surgery, a client may benefit from moving frequently used items to countertop level to avoid reaching or bending (reachers are helpful for lightweight items, but not with heavier things such as large soap bottles or pans). While retrieving items from a cupboard or refrigerator, the client should have one hand on a stable surface. The client should also be aware that carrying items while using a walker poses a safety concern. The client should slide food items across a countertop instead of carrying across the room. A walker tray may come in handy. Walker bags are also useful for carrying covered items.

After all of the above is addressed, it is likely time for discharge! If the client is returning to their home, they should be mindful of the car in which they will be riding home (encourage client to speak with their doctors about when they will be able to resume driving themselves). If at all possible, avoid bringing a car that is either very high or very low. A garbage bag placed on the seat of the car can help the client to slide in more easily.

When receiving all of the above information, the client may begin to feel overwhelmed. It is up to the occupational therapist to present the information in a way that is easy to remember, while attempting to reduce patient anxiety. If clients are concerned about the costs of all of the adaptive equipment, there may be a medical equipment lending facility nearby where the client can borrow items at no cost. Also, most adaptive equipment can be purchased at relatively low cost online. In the end, the occupational therapist plays a very important role in the recovery of clients with joint replacement, and safety is the most important piece of patient education. The above information will help bridge the gap between the clients’ needs and their home situations.

References

Radomski, M. V., & Latham, C. A. T. (Eds.). (2014). Occupational therapy for physical dysfunction (7th ed.). Baltimore, MD: Lippincott Williams & Wilkins.

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