Joint replacement surgery is very common in the UK. More than 252,000 joint replacements were performed in 2018 - around 10,000 more than in the previous year. So how do people recover from these operations? And just how important is physiotherapy?
Thankfully, problems following surgery are rare - fewer than one in 100 people experience severe complications after a hip replacement - and if everything goes to plan, most people are out of hospital after a few days.
All that considered, it's easy to forget that a joint replacement is a major operation, usually only offered to people as a last resort when other treatments haven't worked.
The chances of making a full recovery and living a pain-free life afterwards are high, but rely on closely following your healthcare professionals' advice. You're definitely going to need to moderate your activity, particularly in the short term. However, it's equally important not to stop moving at all, and your team will get you up and walking as soon as possible, possibly on the same day as your procedure.
A crucial part of successful rehabilitation is physiotherapy. The NHS recommends that patients have a minimum of six weeks' physio after a hip or knee replacement but, according to a new study, the amount of physiotherapy people actually receive depends on where they live.
The postcode lottery was unveiled in research conducted by the Universities of East Anglia, Bristol and Oxford, which examined data about more than 37,000 patients in the year following a hip or knee replacement.
It found that patients in London and the north of England are most likely to have physio after a lower limb replacement, while those in the southwest are least likely to have the physio they need. This disparity is not explained by variations in patients' condition before surgery, nor the degree of impairment or disability after it.
What does physio involve?
According to physiotherapist Roger Kerry, patients who don't have sufficient post-surgery physiotherapy, or miss out on it altogether, are at risk of developing problems.
"Physiotherapy helps restore people's joint function and independence after surgery, and can help improve pain management and confidence," he explains.
"Without it, there is always the chance of delayed recover, or, worse still, the patient losing more function than before the surgery because they are unsure what they can and can't do. A patient may also end up in more pain than before surgery if they're not helped with the right rehabilitation."
A programme of rehabilitation after a hip or knee replacement should be led by a physiotherapist, with the aim of supporting the patient to progress independently in time.
"Proper physiotherapy can help build strength, improve balance and reduce the risk of falls, and give the patient the confidence they need to get back their joint function and, where appropriate, to return to work or even sport," Kerry adds. "Studies show that a combination of mobility, strengthening, and balance exercises can speed up and improve recovery."
These exercises could take the form of resistance or aerobic exercise to increase the range of movement in the joint, and could be group-based or one-to-one. In some cases, patients might be offered hydrotherapy, where they perform set exercises in warm water to make functional movement easier.
However, the researchers discovered that the content of NHS physiotherapy varied substantially as well as the frequency and overall availability.
The study found that gender and age also had an impact on the amount of physiotherapy people receive after a hip or knee replacement, with younger, female patients in urban areas accessing more physio than any other group.
This doesn't reflect need, though, since older patients generally need more - not less - physiotherapy, in order to build strength.
Elderly people are also likely to be less steady on their feet and therefore require greater support and encouragement to become confident walking again after a hip or knee replacement.
If you or a loved-one are concerned about getting sufficient physiotherapy and rehabilitation after a lower joint replacement, there are steps you can take. Kerry advises that you discuss your worries.
"You or your relatives and friends can talk with the consultant, physiotherapist or GP to ensure the patient receives proper follow-up physiotherapy after discharge," he says. "Private physiotherapy is an option if there is not a local service with the NHS."
You can get more advice and find a physiotherapist in your area by contacting the Chartered Society of Physiotherapists.