Government mandates, the AAOS and common sense have prevailed to put on hold nearly all scheduled joint replacement and other elective surgeries in Pennsylvania. This likely has been both reassuring for patients and their families as well as anxiety making for those living with end stage joint pain. But, here’s the thing it allows for even more time to get better prepared!
Let’s start with your house…and specifically on your stairs inside, outside, upstairs and to the basement. More falls happen at home, and specifically on the stairs at home. You’re going to want to have a sturdy railing, or 2 on every flight of stairs in your home. Now is a good time to secure what you have so the rail can handle body weight safely. Then head to your bathroom(s) and be sure you have at least a grab bar near the toilet and in the shower/bathing area you will use after surgery. Do not plan to use your towel racks, you will need grab bars. These may require a Handy Man to purchase and install for you and while you may not feel comfortable with that person in your home right now, reserving him or her for the future may be reassuring to them and their business. I have a checklist here with more room by room details; also a link to Mercer County Rehab a direct to patient catalog (with free ground shipping) for other products like elevated commode seats or tub benches. Mercer County even does the extra step of customizing “kits” of equipment by joint to be replaced.
For example, their custom hip kit includes a device to help put socks on, a reaching tool, a long handle shoe horn, a leg lifter, elastic shoe laces and a long-handled sponge.
Now let’s focus on you. What’s your plan after surgery? Are your helpers healthy? Will your surgery depend on someone else helping you? If you’re ok to proceed with your new scheduled surgery date consider you might need a plan A and B for who that person will be or where you will stay after surgery. If anything the coronavirus pandemic has taught us that plans change and flexibility and adaptability are tools we all need. Plan A and B might require you to revisit the home checklist also.
Finally, the best post-operative outcomes come from patients who have been compliant with a pre-operative exercise program. This includes exercises from the discharge program you and your physical therapist designed in anticipation of your pending surgery, or exercise competence with the movements you will begin doing the afternoon after surgery. Feel free to reach out to me if you might need to review those or via Telehealth to develop those exercises, or follow up with you usual therapist.
In my opinion, the most important thing knee patients can do prior to a knee replacement is gain or maintain as fully straight and as fully bent a knee as possible. Heel slides shown here with a strap are the simple best way, 3-5 minutes on a friction free surface is a usual bout. No need to cause a spike in pain but do try over the course of that time to improve the amount of bending and straightness your knee can achieve. You’ll do lots of those after surgery so it's good to be familiar. Use a neck tie or a dog leash for the strap, or certainly you can order a “stretch strap” from many online providers. The single best hip exercise is being able to contract your buttocks muscles independent from all other muscles while you’re lying down, while you’re sitting and as you stand. Glute Sets as they’re called involve isometrically (no movement of the hip joint) squeezing the folds of the rear end together and holding that contraction for 45 seconds in bouts of 4-5 repetitions.
So look at that, you've thought about some things time otherwise might not have let you plan for! Good job. And that brings me to a final point - staying positive. If nothing else this extra time before your procedure might allow you to tap in to some positive mental preparation. There are hundreds of articles on the power of positive thinking, on pain "copers" and on folks who meditate doing better with various stressors including surgery and pain than non copers and catastrophizers. Consider looking in to Norman Vincent Peele and other positive thinkers, basic yoga techniques for breathing and apps like Headspace to help get your head in the right place before your surgery.
Leave a comment with further questions and be patient - this too shall pass and scheduling will return to normal.