Generally, the expectations after revision surgery are not so different than an initial joint replacement (see total hip arthroplasty, total knee arthroplasty, and total shoulder arthroplasty). The idea is the same: to take the patient from a state of pain and decreased function to one of relief and improved function. In most cases, just as in an initial joint replacement, the patient should have orders for full weight-bearing and should be going after full strength and range of motion as soon as they wake up from surgery.
There may however be some differences, and this is on a case by case basis. Sometimes a special reconstruction requires caution. The patient may require immobilization (for example, a knee brace) and protected weight-bearing (for example, using a walker). Such special rehabilitation orders are usually carried out for 6 weeks, but sometimes as long as 3 months.
Here a few examples of postoperative treatments that her different than initial hip and knee replacements:
- Rotating hinge total knee total knee arthroplasty. This requires any immobilization and toe-touch weight-bearing until the 1st postoperative follow-up at 3 weeks. This is advanced to 50% weight-bearing until the 6-week mark. The patient is then full weight-bearing with continued use of walker for safety. At that time a hinged knee immobilizer is placed, and strength and range-of-motion are advanced by 30° every 2 weeks until the 3-month follow-up. Only then is the patient full weight-bearing with no immobilizer
- Revision total hip arthroplasty for instability (dislocating hip). The patient will be fitted with a special brace called a hip abductor orthosis. This will limit the movement of the hip and ensure that it does not dislocate and the soft tissues heal. The patient will also be toe-touch weight-bearing. At the 3-week mark, the brace can be removed when in bed and the patient can advance to 50% weight-bearing. At the 6-week mark the patient is full weight-bearing and no brace.
- If bone grafting or bone graft substitution is used, the patient may have protected weight-bearing until there are significant signs of bone healing on x-ray during clinic follow-up.
- If an infection is being treated, the patient will require prolonged IV antibiotics treatment, which will be prescribed by the Infectious Disease team.
