By Dr. Sean Wells, PT, DPT, OCS, ATC/L, CSCS, NSCA-CPT, Cert DN

Listen to this Podcast on Physical Therapy and Total Joint Replacements

Our expert team of physical therapists at Wells PT share some of the newest research on physical therapy and total knee replacements in our recent free podcast. We include studies from premier publications like Lancet, Hospital for Special Surgeries, and JAMA. Our primary focus is on Total Knee replacements, but many principles like “pre-hab,” or exercises before surgery, and post-surgical physical therapy for other joints apply.

Check out the video below, like and share, and a transcript follows below for those that need it!
Call us today to book a total joint pre-hab or post surgical consultation today: 904-568-1156

Transcript from video:

All right, let's dive deep into knee replacements. We've got a whole bunch of research piled up here ready to help you figure out, you know, how physical therapy could help you out both before and after knee replacement surgery. Definitely a smart move to be thinking ahead.

And honestly, you're not the only one with these questions. It comes up all the time, especially now, you know, with more and more younger people thinking about getting a knee replacement. Younger people, really? That's kind of surprising.

I always figured this was like, you know, something mostly older folks dealt with. What's the deal with younger people needing knee replacements these days? Are they just like way more active, pushing their bodies too hard? Or is it more of a lifestyle thing, like all the talk about rising obesity rates? It really is an interesting trend. And it's not just here, it's worldwide.

But there isn't just one easy answer. You know, a study we've got here, published in The Lancet, has some pretty numbers. It says the average age for a knee replacement is, you know, still around mid-60s, but the number of people under 60 having this surgery has really gone up.

Wow. So it's like a growing trend. Yeah.

They make up about 15% of all knee replacements now. And get this, for those under 60, the chance of needing another surgery, a revision, is around 35% for men. 35% for men.

That's a lot higher than I would thought. Wow. And about 20% for women.

And, you know, half of those revisions happen within the first five years. So it's not just a one and done kind of thing. Hmm.

Are we talking about problems with the implants themselves here? Like maybe they're not holding up as well in, you know, younger, more active people. It's not really so much about faulty implants. It seems to be more about the whole picture of your health.

You know, the research points to things like if you're obese or have diabetes or just your overall health going into the surgery, those things play a big role in how well the replacement works and if you'll have any complications. So it's really about prepping yourself, making sure your body's in the best shape possible before you go under the knife. That makes sense.

It's not just about the surgery itself, which makes me wonder, could physical therapy be one of those things that like tilts the odds in your favor? Could it be a way to, I don't know, maybe even avoid surgery or at least delay it? You've hit the nail on the head. That's one of the most promising things we're seeing in the research. This Lancet study, along with some others, highlights how effective physical therapy can be.

For a lot of people with advanced knee osteoarthritis, it can really improve their symptoms and the kind of programs that seem to work best are those that focus on like strengthening and what's called neuromuscular training. Okay, hold on. Neuromuscular training.

What exactly is that? I've never heard of it. It's like, think of it as improving how your brain and muscles talk to each other. It's about getting those muscles around your knee to work together better to support your knee and control your movement.

And you know what? There's actually a physical therapist who's been doing amazing work with this, Dr. Sean Wells. He has practices in Naples and Ponte Vedra Beach, Florida. He's worked with thousands of people who are getting ready for joint replacement.

Wow. Thousands. All right.

I'm interested. So what's Dr. Wells' like secret weapon here? What makes his approach so special? Now, we can't really endorse specific practitioners, but it is interesting to see what's working well. What we're seeing is that Dr. Wells really focuses on those key principles, you know, building strength, making things more flexible and yeah, improving that neuromuscular control.

He seems to create individual exercise plans for each patient, taking into account their, you know, specific needs and limits. Ah, so it's not just like a one size fits all approach. It's really personalized.

Yeah. That's great. So it sounds like physical therapy could potentially help folks put off knee replacement, maybe even avoid it altogether.

But what if even after trying everything, you still need surgery? Is physical therapy still important then? And what about, you know, the whole partial versus total knee replacement question? I know you've got some research on that too. You're totally on the right track with those questions. Let's unpack those options a bit.

Total knee replacement or TKR, that's when they replace the entire knee joint with an implant. And then there's partial knee replacement, UKR, which is when they just replace the part of the knee that's damaged. So two different approaches.

I'm guessing, like with most things, each has its pros and cons. You got it. TKR is the one they do most often and it generally lasts longer.

The downside is it's a more invasive procedure. UKR, on the other hand, isn't as invasive. So you might recover faster and have a better range of motion.

But here's the thing. It might not be the right fit for everyone. And in the long run, you might have a higher chance of needing another surgery.

So there are tradeoffs to think about. OK, I see. So no matter which type of replacement someone needs, is physical therapy still a big part of getting better? It really is.

Physical therapy is key, both before and after surgery. It's super important for helping you regain strength, mobility and function. So you can get back to doing the things you love.

You know, there's a study actually in the New England Journal of Medicine. They followed patients with knee osteoarthritis who were eligible for total knee replacement. What they found was those who had the surgery and then did a structured physical therapy program, they had much better results, way less pain and better function compared to those who just had non-surgical treatment.

So you can't just have the surgery and call it a day, right? You've got to put in the work, the physical therapy, to really reap the benefits. Makes sense. But how is physical therapy after surgery different from what you do before surgery? That's a great question.

After surgery, physical therapy usually starts out pretty gentle. You'll start with exercises to, you know, get the swelling down and gradually get your range of motion back. It's all about easing back into movement, you know.

Then as you start to feel better, the focus shifts to strengthening those muscles around your knee and functional training to help you get back to your normal everyday activities. So it's like a step-by-step process tailored to, you know, how you're recovering. And I'm guessing there's a lot of focus on making sure you're moving correctly, safely.

Exactly. Physical therapists are the pros at guiding people through this, especially after surgery. They'll put together a safe and effective plan that takes your individual needs and limits into account.

And here's something interesting. The research is really emphasizing what's called early mobilization, basically getting you moving as soon as possible after surgery. Early mobilization.

That seems kind of counterintuitive, doesn't it? Wouldn't you want to rest and let things heal after surgery? You'd think so, right. But studies have shown that early controlled movement actually helps prevent complications like blood clots and it can speed up how fast you recover. It's about finding that balance between rest and activity.

So you're not just, like, lying in bed. You're actually working to get back on your feet. That makes sense.

It's almost like the stronger you are going into surgery, the smoother your recovery might be, right? You're totally right. Building up your strength and flexibility before surgery can really set you up for a better recovery. It's like training for a marathon.

The better prepared you are, the better you'll perform. And going back to Dr. Sean Wallace, it seems like that's exactly what he's doing with his approach to pre-surgery physical therapy. That's right.

He's all about building that solid foundation. Okay, before we wrap things up, I want to go back to something we talked about earlier. The whole mental and emotional side of knee replacement.

Yeah. You know, it's a big decision and I bet there are a lot of worries and expectations going through your mind, listener. You're not wrong.

The mental and emotional side of this is just as important as the physical. There's some research that really speaks to this. A study in the HSS journal, which focuses on orthopedic surgery, found that how satisfied people are after a total knee replacement is really tied to whether their expectations going into it were met.

That makes a lot of sense. I mean, if you go into it with unrealistic expectations, you're probably going to be disappointed with the outcome no matter how well the surgery went. Exactly.

It really underscores how important it is to be involved in your own healthcare. You know, have those open and honest conversations with your surgeon and physical therapist. Ask all the questions you have, be clear about your expectations, and really understand what you can realistically expect from surgery and recovery.

That kind of proactive approach will help you make the best choices for your needs. So knowledge is power. The more you know, the more confident you'll feel as you go through this.

That's got to be one of the biggest takeaways from this deep dive, wouldn't you say? For sure. It's about giving yourself the knowledge and understanding to make informed decisions about your health. And that brings to mind something else, the decision making process when it comes to choosing between a total and a partial knee replacement.

Yeah, that's a big one. What were your thoughts on that? Well, the research seems to be saying that people's preferences and individual needs should be at the center of that decision, not just meeting certain pain or function levels, but thinking about your lifestyle, how active you are and your long term goals. You're right.

It's not a one size fits all situation. A partial knee replacement might be a good option if you're younger, more active, and the damage is limited to just one part of your knee. But if you have more widespread damage, a total knee replacement might be the better choice.

And it's not just about the type of replacement, but finding the right surgeon too, right? Someone who really listens to your concerns, understands your needs, and is committed to helping you get the best possible result. Couldn't agree more. It's about finding a surgeon you trust and feel comfortable with, someone who's willing to answer all your questions and work with you as a partner.

And that goes for finding the right physical therapist too. You need someone who understands your goals, creates a plan just for you, and helps you stay motivated during recovery. And speaking of physical therapists, I have to mention Dr. Sean Wells again.

His practice in Naples and Ponte Vedra Beach, Florida seems to be doing some really cool stuff. It really does. It's great to see medical professionals taking the latest research and putting it into practice to help their patients.

Okay. We've covered a lot of ground here. The benefits of physical therapy, the details of total versus partial knee replacement.

We've really dug into the key things you need to know. So let's do a quick recap for our listeners. You know, hit those key takeaways one more time.

Sounds good to me. Okay. So first things first, physical therapy, it's a game changer.

It can really help with knee pain and might even help you avoid knee replacement altogether or at least delay it. And remember, even if you do end up needing surgery, physical therapy is super important, both before and after. It's all about making that recovery as smooth as possible and getting you back to doing the things you love.

Right. It's about being proactive. You're not just like a passive patient.

Yeah. It's about what you do before and after surgery to really set yourself up for success. Absolutely.

It's a journey and having a good physical therapist is like having a guide for that journey. And speaking of the journey, we can't forget that deciding between a total and a partial knee replacement is a big deal. It's a decision you should make with your surgeon, you know, considering your own specific needs and what's going on.

It's all about personalized care, finding what works for you and your situation. Exactly. Well, there you have it, a deep dive into the world of knee replacement with a special shout out to the power of physical therapy.

We really hope this information helps you take charge of your knee health, you know, and find the relief you deserve. Remember, knowledge is power. Knowing what to expect, understanding your options and advocating for your needs can make a world of difference in your journey towards better knee health.

Couldn't have said it better myself. A huge thank you to everyone for joining us on this deep dive. Hopefully you found it informative maybe even a little bit fun.

Remember, you're not alone in this. There are tons of resources out there, experts to guide you and a whole community of people who get it. So keep learning, keep asking questions and keep moving forward on your path to a healthier, happier you.

And don't hesitate to reach out to a qualified physical therapist to get started on that prehab journey. You might be amazed at how much it can help. Absolutely.

Whether you're trying to avoid surgery or recover from it, physical therapy can be your secret weapon. So take that first step and invest in your knee health. You won't regret it.

We're rooting for you every step of the way.