A Q&A with Suzanne Denis
Advanced Practice Physiotherapist, Orthopaedics, Arthroplasty Program, 
Holland Centre, Sunnybrook Health Sciences Centre

What are some concerns that people might have if their joint surgery is delayed?

There are several common concerns that people with osteoarthritis (OA) might have if their surgery is postponed.  The two most common include wondering, “Won’t activity further damage my joint?” and “If I wait, won’t my joint get so bad that they can’t operate on me?”  Dr. John Murnaghan, orthopaedic surgeon at Holland Bone & Joint Program, Sunnybrook Health Sciences Centre, assures patients that rarely does a delay in surgery result in a problem that surgeons cannot technically manage. Furthermore, most activities that people engage in tend to be low impact and will not damage the hip or knee joint. Activity will maintain your joint health as well as your general health. Being inactive is a greater health hazard.

What are some of the issues that might arise if a person’s joint surgery is delayed?

There are a number of issues that affect both the joint and general health that can be associated with osteoarthritis and a delay in surgery. Possible issues related to the joint include a decreased range of motion and stiffness due to soft tissue tightness, as well as increased pain and risk of falling due in part to muscle weakness and decreased activity. Decreased physical activity has a huge impact on general health and is associated with anxiety and low mood. It can result in weight gain and greater fatigue, as well as increase the risk and impacts of other chronic health conditions such as diabetes, high blood pressure, heart disease, stroke and cancer. The good news is thatthe majority of these issues are modifiable. In other words, you can do a lot to limit the effects of osteoarthritis. 

What are suggestions or strategies that people with arthritis can follow to reduce the negative impact of a surgery delay?

Remain as active as possible. Activity has been shown to:

  • Increase energy levels

  • Improve mood and decrease social isolation

  • Reduce risk of chronic disease or help improve  quality of life 

  • Reduce falls risk 

  • Maintain muscle strength

  • Reduce pain

  • Help joint mobility and joint health - yes, even if you are told you are “bone on bone”

  • It can be hard to motivate yourself to remain active if you are in pain. Strategies for success include:

Choose an activity that you enjoy, that requires little effort or organization, and that provides other benefits such as being outdoors, being with other people, quiet time for yourself, or stress management. 

  • If walking is painful, you don’t trust your legs to support you, your balance is poor, or if you start to limp, it is safer and better to walk with assistive devices such as walking poles, cane(s) or a walker.

  • If weight-bearing activities are limited because of pain, consider activities that put less of a load on the hip and knee joint such as: walking with hiking poles, using an elliptical machine, biking, rowing, swimming, aqua fit, walking in water, yoga, chair yoga, or tai chi. 

  • Consider pacing your activities by doing a bit of activity then taking a break or doing something different. This will still contribute to your health while managing your pain and energy levels.

  • Simple strengthening exercises that can be done at home can help your pain, reduce falls risk and help you maintain your mobility and independence.  For exercise examples, see the Arthritis Society’s Osteoarthritis Exercise Videos, particularly exercises for quadriceps, hip extensor and hip abductor strength if you have arthritis in the knee or hip.

  • With arthritis, sometimes soft tissues (muscles and ligaments) can get tight and limit your range of motion. In order to walk normally you want to maintain how straight you can get your knee and how far you can “extend” your hip. The Arthritis Society’s video Exercises for Osteoarthritis of the Hip & Knee contains a helpful knee extension exercise for knee OA, as well as a hip flexor/groin stretch if you have hip OA.  

What should people be doing to prepare for surgery while they wait, both long-term and as it gets closer to their surgery date? 

Remain active. This will help you maintain your energy levels to support your post-operative recovery and rehabilitation. If your usual activity becomes too difficult, consider trying another activity that may be easier. Keep moving - your physical and mental health depend on it!

  • Continue with the strength exercises described above. These exercises are critical as they will also be part of your post-operative recovery program. The stronger you are before surgery, the faster you’ll be able to return to your everyday and leisure activities after.  

  • You may also want to include chair push-ups in your exercise routine. This exercise will help you get up and down from a sitting to standing position after surgery if your legs are weak or painful. Sit in a chair with arm rests, place your hands on the armrests, lean forward and push yourself up into the standing position, then lower yourself with control. Repeat 5 to 10 times.  

  • Continue with your stretching and mobility exercises. If you have knee arthritis, it is critical you try to maintain your ability to straighten your knee to be able to walk normally. The surgeon will make sure your knee straightens in the operating room, however if your soft tissues are tight, you will have to work harder to maintain the ability to straighten your knee after surgery.  

  • A very detailed booklet to help you prepare for surgery has been produced by The Canadian Orthopaedic Foundation. Topics include many practical things you may not have thought of to ensure the success of your surgery such as: having dental work done before surgery, smoking cessation, renting assistive devices you may need, coordinating rehabilitation you may need, and setting up your home.   

Reducing wait times for joint replacement surgeries is a top priority for the Arthritis Society and the need is even more urgent due to the additional delays as a result of COVID-19. To join the Arthritis Society in advocating for a coordinated plan to reduce both the COVID-19 impacted surgeries and the pre-existing backlog, visit our Take Action page and have your voice heard.

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