Joe: 00:15

Welcome back to another episode of the Freedom Talks podcast, everybody. This is your host, Joe Ogden. And this week, we're gonna talk a little bit about joint replacements, total joint replacements. As a physical therapist, especially in the private practice outpatient setting, this is something we see a ton, and it's really all joints. I've seen pretty much every body part, I think, that can be replaced from big toe to hip, knee, shoulder.

Joe: 00:47

It's it's something that it sounds super daunting, I think. And the process itself, the end goal, in my experience, as long as things are communicated in the right way and we educate patients correctly and and we really make sure we work towards their goals, the end product is what most people are hoping for. And I think a lot of joint replacements themselves, it seems like it's it's this big task that we we can accomplish. And what I try and really talk to people about is is all of the peaks and valleys that go along with with the recovery are all normal, and we just need to push through that because we know what the end goal is. I think the biggest one that we see, and I don't see our numbers.

Joe: 01:45

I'm just speaking statistically speaking here as far as, our specific numbers at Freedom Physical Therapy. But I think as a whole, the most common joint replacement itself is a knee replacement. And what I'm gonna talk about today, the the concepts themselves apply to any joint. But we're gonna talk specifically today about the knee. But, again, a lot of these concepts will transfer over if you're having a hip replacement, having a shoulder replacement.

Joe: 02:16

It doesn't matter. But today, again, we're gonna focus on the knee replacement itself. So benefits of a total knee replacement. What I always tell people is when you go in or let's even back up. Let's not even get to the surgery part itself.

Joe: 02:33

Let's talk about leading up to surgery. So typically, as we age, and this is very normal, as we age, joint space decreases. Because of gravity, we lose joint space. I've seen some people where their joint space is really great and there's some research, pointing towards the more active people are, the the better they're gonna feel. But that's not always the case.

Joe: 03:00

Again, typically, as we age, joint space will decrease. A lot of people will start developing knee pain. What'll happen is the nice part in Wisconsin, and I think this is changing slowly but surely, which is really good, is people start having knee pain and and they come in and see a physical therapist first and say, hey. I'm having this knee pain. You know, can we take a look at it?

Joe: 03:19

And as a physical therapist, we go through all this special testing, check the range of motion, check the strength, make sure there's not any ligament damage, any meniscus pathology. And let's say everything comes out clean, range of motion is decreased a little bit because, again, that joint space is decreased. We've got some swelling in the knee. And we're like, alright. You know, I I I think we've got some just knee arthritis going on.

Joe: 03:43

And we're like, alright. Let's let's go see an orthopedic just to make sure that they'll take an x-ray, take some imaging just to make sure that there's something crazy going on. Go in and get an x-ray taken, and it comes out. Yep. There's some arthritic change in the knee.

Joe: 04:01

I want you to go to physical therapy. What happens at that first initial stage is we've got to make sure that we address all muscle weakness around that joint. Because what happens is your body senses that there's a change going on in the knee, and it actually shuts down the muscles around the knee because your body wants to rely on those passive insufficiencies to be stable. And really, we want active insufficiency. So we need that muscle.

Joe: 04:26

So we kinda gotta reteach the body a little bit that, hey. It's okay that we've got this quote unquote injury, but it doesn't really matter. As long as we're strong around that joint, there's a lot of people that don't have any knee pain. I tell people all the time, I see people that and I love looking at imaging because I think it's just super interesting. I've seen people that have, on imaging, the worst knees or hips that you could possibly imagine.

Joe: 04:48

They don't have any pain. And I'm like, oh, you know, what brings you here? Like, I don't know.

Joe: 04:52

I just saw the doctor and thought it'd be good to

Joe: 04:53

come here. On the other hand, I see people that imaging looks fairly clean and their knee pain is through the roof. So it's not always equal as far as what's gonna show up on an image and how you're gonna feel. So that's something that I tell people all the time is don't let the image dictate how you feel. Just let how you feel dictate how you feel, and we gotta adjust accordingly.

Joe: 05:15

So we go in. We we get an objective assessment from a physical therapist, very thorough. We look at how the knee moves and what some muscle weakness may be causing with, your walking, with just how you do functional movements. And I ask people all the time, like, what are you struggling with? You know, squatting, lunging, whatever.

Joe: 05:33

Okay. Let's look at that and let's adjust it. So we go through physical therapy, and a lot of people that and studies show this, then this can be looked up is physical therapy helps right right off the bat. I see a lot of people that come in. You know, we're talking about maybe getting a knee replacement.

Joe: 05:52

They said try physical therapy first. We get done with eight weeks, twelve weeks of physical therapy. I'm like, I feel really good. Perfect. Let's ride this wave out as long as we can.

Joe: 05:59

We wanna elongate this period as long as we can. Because and I say to patients too, and and it's partially a joke, but at the same time, it's is very serious. I have yet to meet someone that wakes up and says, man, I can't wait to have surgery today. I mean, for the most part, nobody wants to do the surgical process itself. I mean, it's not terribly fun.

Joe: 06:22

We want the end product to to fix ourselves, but nobody wants to go through the actual surgery part. And again, I'd I'd say that more as a joke, but it is can be applied seriously as well. So let's say we get to someone and, you know, physical therapy doesn't really take away the pain and we you know, they've tried a cortisone injection and takes some of the pain away and that hasn't helped and we're like, okay. I think it's time for the knee replacement itself. What I think is super important is and I'm see again, seeing this more and more, which I think is great.

Joe: 06:53

It it it can only help. It's not gonna hurt people. As you come in, and some people, it's a couple, appointments. I've had a couple patients where, you know, just life has gotten in the way and they pushed off their knee replacement, and we basically do a full, six to eight weeks of preop strengthening. And then they go in, have the knee replacement, and actually the post op does fairly well.

Joe: 07:14

We we had one this summer, in 2024 that he did fantastic. And I I tell I told him all the time, I wish I we could have cloned you to to have both knees done and one had the preop and one didn't to really see the true benefits of the preop, or if it was just you know, his body did really well. I mean, he did absolutely fantastic. But let's fast forward that we've got the knee replacement in the hospital. They they wanna get get you up and moving as fast as possible.

Joe: 07:46

A lot of people go in and and leave the next day. It it's it's a really quick turnaround time. And then I wanna see you right away, as quick as we can after the surgery. I see a lot of people two days later, three days later. If it's on a Friday, I'll see you on a Monday or Tuesday.

Joe: 08:01

And we get that knee moving right away. The nice part about knee replacement is the only two ways to really injure your knee and again, one of one of this is a joke, but two, it it just shows how strong that knee is. Is the two big things you need to worry about is one, falling on that knee. And nobody wakes up and says, oh, I can't wait to fall today. So that most people don't try and do that.

Joe: 08:24

The second one is you gotta hit get hit by a car. And that second one, again, is a joke, but it shows just how strong that knee is. Some people come in, they're like, god. You know, it just hurts so bad. I'm like, it's okay.

Joe: 08:34

We just gotta push through it. This first phase is is gonna stink. We gotta get through the first three weeks of bending and straightening that leg, and that's gonna stink. Once we get that motion going, it gets better. It gets better.

Joe: 08:46

It gets better. I tell people ride this wave out, get through the first three weeks, and it's pretty much downhill sledding from there. I mean, there's gonna be some, you know, hiccups along the way, but for the most part, in general, it's kind of downhill sledding. So getting through that first three weeks, getting that leg straight, that's the key. If we get that leg straight in the first couple weeks, it it's so much better.

Joe: 09:08

I see a lot of people where you know, I'm super nice about it. I offer the incentive. If you get this leg straight and I don't have to push on you, it's gonna be a better experience for you. It's gonna be a better experience for me. I have no problem pushing on that leg to get it straight.

Joe: 09:23

I'm a big bigger guy. So, I mean, I I I can do it. I I don't particularly enjoy it because people don't like me when we have to push it straight, but I can do it. If you can get it straight at home, you're just you're just gonna like physical therapy more. And the more you do at home, the better.

Joe: 09:41

I give people, a big printout of, you know, this basic bending, basic straightening, straight leg raise, active quad set, get that leg straight as fast as possible and get that quad going. The first couple sessions, I work every position to try and get that quad firing. That's my biggest biggest thing. I see so many people that, you know, I even see them later down the line and their quad is just not firing right. I want that quad to get firing as fast as possible after surgery.

Joe: 10:11

When the quad's firing, it protects the knee. And that goes I mean, that's the same for any other joint as we gotta get those muscles firing around that joint to take pressure off. It'll take pain away. Once the muscles come back, pain really gets better because we don't rely as much on the joint. So as far as, you know, an exercise routine, the biggest thing is just you gotta be active.

Joe: 10:31

You gotta move. I see a lot of people that have recumbent bikes at home. I mean, that works really great. I tell all my knee replacement patients or patients that have, knee replacement or any joint replacement is come on in. If you come in before your appointment, get on the bike, get things moving because it just helps when you're looser when we start the session.

Joe: 10:53

I always finish with it a little bit too, at the end just to have people just, you know, extend their treatment time a little bit and just be in the clinic, be in this recovery because I want them after the session to be tired enough where they can go home and rest. I don't want to finish our session and then be like, alright. You have another half hour of things on top of this. You know? I wanna get everything done and be as efficient as possible during the treatment sessions so that we can recover, you know, as fast as possible and speed this process up.

Joe: 11:23

So a knee replacement itself, I give people, you know, twelve weeks is really kind of the big, marker. The three month mark is is really where we wanna see the the most improvement. And then from there, it's just kind of adjusting to, you know, kind of functional things we do in in our life. And a lot of people, once we get that full range of motion, especially being straight, bending will come. And we get back to doing stairs.

Joe: 11:50

We get back to doing everything we need to. And then the sessions kinda become and I I leave this open. I always have a plan going into, you know, how I treat people. But when I see people weekly towards the end of treatment, what I like to do is be like, we finish a session, we can we say, okay. This is what I want you to work on, x, y, and z.

Joe: 12:11

And then you come back next week and you're like, alright. X, y, and z is really good, but I'm still struggling with a, b, and c. Okay. Let's look at those things and figure out, okay, what do we have to adjust? What do we have to add into your program?

Joe: 12:21

And then you work on a, b, and c for a week. And then you come back and you're like, alright. This is really good. Now I'm having trouble with this. Okay.

Joe: 12:27

So that recovery is always kind of a moving target, which I think is really fun. And then people are able to see the progress that they're making. And they also what I like about that kind of setup later in the recovery is I think it gives patients more of an ownership and more lead in their rehab program. I'm always the one that's steering the ship, so to speak. But they're putting in the work and they're seeing the work that they're doing is having a positive impact on their life, which for me as a physical therapist, I I think a lot of my job is empowering people to take advantage of what their body can do and show them what their body can do.

Joe: 13:03

So that if something happens again, they're like, okay. I know last time I was working with Joe or or Anna or whoever we have at Freedom, this is what we worked on with this problem. Let me try this. Oh, my problem is better. Or, like, ah, it's kinda better.

Joe: 13:18

I gotta come back in, and then you come in and you're just like, alright. This is what's going on. This is what I've been doing. Oh, okay. Perfect.

Joe: 13:23

We just gotta adjust this. It just works a whole lot better. So in conclusion, one, don't be afraid of a total joint replacement. Yes. The first couple weeks stink.

Joe: 13:37

There's no better way to put it. It stinks. However, with your end goal in mind, things will be better. You're gonna go back to being anatomically perfect after that replacement. I always say, in the Milwaukee area here in Wisconsin, we are very spoiled with very, very, very, very good orthopedic surgeons.

Joe: 13:56

Surgeons. I don't there's nobody. Nobody. Nobody. Nobody.

Joe: 13:59

That patient's coming in like, you know, I'm having so and so do my surgery. I'm like, oh, perfect. We have a great working relationship with them. They do a great job. They'll take good care of you.

Joe: 14:07

We'll take good care of you, and you're gonna be really happy with this end product. Everybody is so talented in this Milwaukee area, and I think it's very unique. And quite honestly, we're very spoiled to have the opportunity we do as patients that whoever we need to see, we're in really good hands. So if you need a joint replacement or think you might need one, come on and see us here at Freedom. Let's have a look.

Joe: 14:30

Let's get you going. Let's make sure we get you going on the right path and get you back to what you need to do. So thanks again for listening to another episode of the Freedom Talks podcast here, everybody. And we'll see everybody in a couple weeks on the next episode.