Repeal & Replace: The Upsides to Exercise-Prep for Joint Replacement

With the aging population of Baby Boomers, and their elders, the US healthcare system is facing a tsunami of patients with knee and/or hip pain that ultimately will require a replacement, or arthroplasty, to reduce pain and increase function. Estimates vary but recent data suggests that we’re doing over 700,000 knee arthroplasties and 400,000 hip arthroplasties a year. Any non-pharmaceutical, non-surgical effort to minimize the debilitating effects of a damaged joint and to defer the need for arthroplasty not only saves the healthcare system money; it also preserves the prospective patient’s quality of life until such time. And if these efforts help prepare the neuromuscular system for the post-surgical rehabilitation process, they may reduce costs to the system and to the individual as well as restore a pain-free, high-functioning quality of life. This course will introduce the concept of pre-habilitation for those anticipating or gearing up for a joint replacement for the knee or hip. It is not designed to elucidate the various mechanisms and pathologies that might lead to the need for a replacement. But it will, in the context of the exercise recommendations, address the many weaknesses and compensations that those with advanced hip and knee pathologies have experienced and will need to correct post-surgery while in physical therapy. The rationale for each exercise will help the exercise professional improve the pre-surgery condition of the neuromuscular system and prepare it for the therapies ahead. 

Course Learning Outcomes: After completing this course, you will be able to:

1. Understand the mechanisms of the development and effects of OA of the knee and hip;
2. Understand how the biomechanics and neuromuscular adaptations of late-stage OA impact movement and function;
3. Understand how pain, inflammation and overall fitness impairment need to be managed and considered in the design of fitness programs pre-surgery;
4. Design and implement various exercise techniques and modifications to help prepare the surgical candidate for the physical and maybe even emotional aspects of surgery, rehab and post-rehab life; and
5. Facilitate the rehab process and expedite both recovery from the surgery, in conjunction with the physical therapy, and the restoration of an active lifestyle.

2 CEC Course

Course Presenter:

Irv Rubenstein, Ph.D. in exercise science (Vanderbilt University), spent his middle years practicing near-daily as a martial artist. He also founded STEPS Fitness since 1989, Nashville’s first exclusively personal training center. Three joints later, having experienced the effects of osteoarthritis till replacements were the last option, he brings his studies, experiences and insights to the field of pre- and post-rehab. Dr. Irv has taught continuing education classes nationally for Exercise ETC (Ft. Lauderdale), developed exercise ‘kits’ for Visual Health Instruction (VHI: Tacoma, WA), presented at various national conferences on topics ranging from eating disorders and weight management, contributed to books and articles pertaining to exercise and fitness, served on the local Arthritis Foundation and Eating Disorders Coalition of TN (now called Renewed) boards, was a founding member for the Medical Fitness Network, and still trains 45-55 client-sessions per week. Irv is a contributor to MFEF.