Ask the doctors: Prehab program can lessen recovery time after surgery
Q: I am 68 years old, and I am going to need a hip replacement. I've been reading about it, and some people say that you can prepare yourself physically so that you will do better after the surgery. Do you know if this works? If so, what do you need to do, and when?
A: This approach to surgery is known as prehabilitation, or prehab. While rehabilitation (rehab) focuses on recovery after orthopedic surgery, prehab focuses on preparing before surgery. The idea is that increasing physical strength and stamina can lead to a better and faster post-surgical recovery.
In hip replacement surgery, the damaged portions of bone and cartilage in the hip joint are removed. The surgeon then replaces them with new implants made of a combination of metal, ceramics and polymers or plastics. After surgery, patients often deal with limited mobility and decreased muscle strength. This is particularly true in early recovery.
Research into prehab has shown it can help patients recover strength and range of motion more quickly than those who don't prepare. This, in turn, gets them on their feet and mobile in a shorter time frame. Prehab has also been shown to reduce the need for follow-up inpatient care.
A prehab program for hip replacement often begins six to eight weeks before surgery. It should be done with a physical therapist, who will begin with an in-depth assessment. This is important because the pain and limited range of motion that trigger the need for a hip replacement often affect the biomechanics of how you walk, sit, stand and move.
Exercises typically focus on strengthening the muscles of the back, legs and core, and include a cardio component to improve stamina. It can also be helpful for people to learn about the exercises they will perform following their surgery.
Some prehab programs include guidance on how to prepare your home for a safe recovery. This includes removing tripping or slipping hazards, such as area rugs, electrical cords or ground-level decor.
Another important part of prehab is selecting and learning how to use the support and stability devices you will need in the early days of recovery. These may be crutches, a walker with or without wheels, or a walking cane.
Not surprisingly, diet also plays a key role. You can boost your body's ability to heal by getting plenty of lean protein, fatty fish, fresh vegetables, leafy greens and fruit; cooking with healthy oils; limiting alcohol; and avoiding ultra-processed foods and added sugars.
The data show that people who complete a prehab program can have a faster recovery with less pain, less downtime and less need for post-operative care. If you would like to prepare for your own surgery with a prehab program, ask your doctor to recommend a physical therapist with experience in prehab.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.
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