Fractures and joint replacements

You will normally be seen by a physiotherapist if you stay on an orthopaedic ward.  Orthopaedic patients include:  

• Trauma patients: e.g. people with neck of femur (hip) fractures, lower limb fractures, upper limb fractures, spinal fractures and many other musculoskeletal and soft tissue conditions following a fall or accident.

• Elective patients: e.g. patients who have procedures such as a knee, hip or upper limb replacement, a knee ligament reconstruction (e.g. anterior cruciate ligament), spinal surgery or foot surgery.

Your initial assessment will usually be the first day after your operation, but this depends on the instructions from your consultant.  The initial assessment will usually last 15-30 minutes.  The assessment will depend upon your symptoms and your surgery and can include:

• The range of movement at your joint.
• Your muscle strength.
• The length of your muscles (tightness).
• A balance assessment.
• A stairs assessment.
• Whether there are any changes in your sensation.
• Your mobility (way of walking) with or without a walking aid.
• A review of your usual activities of daily living.
• Possibly listening to your breathing (chest assessment).

Your physiotherapist will discuss the findings of their assessment with you.  He or she will then work with you to agree an appropriate treatment plan and goals for your treatment.

Depending on your individual needs, your physiotherapist may suggest some of the following:

• Range of movement exercises.
• Muscle strengthening exercises.
• Balance exercises.
• Transfer practice (e.g. practising getting up from a chair).
• Mobility practice (with an appropriate walking aid).
• Stairs practice.
• Progression of mobility and gait re-education.

Depending on your progress you may need follow-up after you have been discharged from hospital. Your options will be discussed with you but may include:

• A further stay (as an inpatient) in a rehab hospital or rehab unit. 
• A follow-up physiotherapy outpatient appointment.
• A home visit from a physiotherapist.
• Attending a fracture clinic.

If you are able to go home but need help with some of your daily activities, you may be entitled to temporary support from your local authority's Enablement (or Reablement) team. For example, if you are not able to get washed or dressed on your own, Enablement (or Reablement) support workers can help you for a few weeks, encouraging and supporting you from day one to do as much as possible yourself.  The therapy staff in the hospital will be able to advise you about the support available locally and whether it would be appropriate for you.

If you need any equipment on your return home (for example a raised toilet seat), the hospital can organise a home visit by a member of the occupational therapy team.  The occupational therapist in the hospital will be able to advise you about the support available locally and whether it would be appropriate for you.

You can help yourself while you are in hospital and when you go home, by following the advice and instructions given by the consultant and physiotherapist. You may be given a patient information leaflet specially designed for the surgery that you have had.  If this is the case, please follow the instructions carefully.