Joint endoprosthetic rehabilitation programme

Rehabilitation after endoprosthesis in Vilnius, Paupio Kinezioteka Clinic Centre. Rehabilitation after joint replacement with modern simulators and exoskeletons. Individual rehabilitation programmes for hip, knee and shoulder joints in Vilnius. Make an appointment for a consultation!

Rehabilitation programme after joint endoprosthesis in the centre ‘Paupio Kinezioteka Clinic’.¶

Features of rehabilitation after joint endoprosthetics in the centre ‘Paupio Kinezioteka Clinic’.¶

Endoprosthetics is a surgical operation to replace a damaged joint with an artificial implant. Such intervention is required for severe forms of osteoarthritis, injuries, rheumatoid arthritis and other diseases when conservative treatment fails.

Which joints require special attention during rehabilitation?¶

Hip joint - the most common replacement, requires careful restoration of mobility and strengthening of the pelvic muscles.
Knee - rehabilitation is aimed at restoring stability and range of motion.
Hand joint - a complex process due to high mobility, requires gradual increase in load.

Rehabilitation timeframe¶

Early stage (1-6 weeks) - pain reduction, restoration of basic mobility.
Late stage (6-12 weeks) - muscle strengthening, return to daily activities.
Full recovery (3-6 months or more) - adaptation to activity, return to sport (if necessary).

Rehabilitation methods in ‘Paupio Kinezioteka Clinic’.¶

Our centre uses modern approaches with proven effectiveness:

Kinesiotherapy - individualised exercises to restore mobility, strength and coordination.
Bubnovsky Method - a system of adaptive exercises aimed at activating the body's internal reserves.
Physiotherapy and massage - to improve blood circulation and accelerate regeneration.
Posture and gait control - correction of movement patterns to prevent complications.

We provide a comprehensive approach to help patients return to active life with minimal discomfort and risk of complications.

Why endoprosthetics do not solve all problems and why do we need a comprehensive approach?¶

What are the causes that joint replacement does not solve?¶

Endoprosthetics restores the function of a damaged joint, but does not address the underlying causes of joint damage such as:

Biomechanical abnormalities (pelvic misalignments, scoliosis, flat feet) - leading to uneven loading of the joints.
Muscular imbalances (weak gluteal muscles, lumbar hypertonus) - causes wear and tear on neighbouring joints.
Neurological problems (pinched nerve roots, spasms) - cause chronic pain and limited mobility.
Overweight - puts constant strain on the musculoskeletal system.

Without correction of these factors, the risk of reoperation increases dramatically:
- Hip replacement is often followed by wear and tear on the knee joint.
- Uncorrected spinal misalignments accelerate degeneration of the neighbouring spine.

Why should endoprosthetic rehabilitation be comprehensive?¶

At "Paupio Kinezioteka Clinic" we work not only with the effects, but also with the causes, using:

Kinesiotherapy - strengthens the deep muscles that stabilise the joints and spine.
Bubnovsky Method - relieves muscle spasms, restores blood circulation.
Correction of posture and gait - eliminates overload through correct motor stereotypes.
Metabolic therapy - combats excess weight and inflammation.

Example:
A patient after TBS replacement often ‘spares’ the leg by shifting weight to the healthy side - the knee joint becomes overloaded - 2-3 years later it needs to be replaced. Our task is to break this cycle.

Important!

Endoprosthesis is only the first step. To avoid a ‘chain reaction’ of joint destruction, rehabilitation should include a complete reset of the musculoskeletal system.

Physiological processes and timing of rehabilitation after joint replacement surgery¶

Hip Replacement Rehabilitation¶

After hip arthroplasty, a complex process of biological integration of the implant is initiated in the body.

In the first 4-6 weeks, a connective tissue capsule is formed around the prosthesis - this process is called biological fixation. At the same time, the blood supply in the area of surgery is restored: new capillaries grow, which contributes to the healing of the soft tissue.

During this period it is especially important to dose the load, as excessive activity can lead to instability of the prosthesis, and insufficient activity can lead to thrombosis and muscle atrophy.

If the physiological recovery time is not respected, serious complications can occur.

Too early loading (in the first 2-3 weeks) can cause loosening of the prosthetic components due to incomplete bone integration.

On the contrary, prolonged immobility leads to contractures, thrombosis and pronounced hypotrophy of the thigh and buttock muscles, which further disrupts the biomechanics of walking and overloads the lumbar spine.

Knee joint¶

Rehabilitation of the knee joint after endoprosthesis requires special attention to the restoration of proprioception - the ability of the joint to sense its position in space.

During the first 6-8 weeks, the neuromuscular apparatus adapts to the new joint: motor stereotypes are reorganised, neuromuscular connections are restored. At the same time there is a process of bone tissue restoration in the places of contact with the implant, which lasts up to 3-6 months.

Violation of physiological terms of knee joint rehabilitation is especially dangerous.

Too aggressive early rehabilitation can cause peri-prosthetic oedema and inflammation, which slows down the process of bone integration.

Insufficient development of the joint in the first 3 months leads to the formation of rough scar adhesions and permanent contracture, which can only be corrected by surgery.

Shoulder joint¶

Shoulder arthroplasty triggers unique recovery processes due to its anatomical complexity.

During the first 2 months, the rotator cuff adapts to the new joint - the muscles learn to work under the changed biomechanical conditions. Of particular importance is the restoration of microcirculation in the area of surgery, as the shoulder joint has an abundant blood supply, but is prone to postoperative oedema.

Rotator Cuff of the Shoulder

The shoulder rotator cuff is a complex of four muscles and their tendons that surround the shoulder joint, providing stability and a wide range of motion.

Composition of the rotator cuff:
1. Pectoralis muscle - pulls the arm to the side
2. Apsoas muscle - rotates the shoulder outward.
3. Small round muscle - assists in external rotation.
4. Subscapular muscle - responsible for internal rotation.

Key Functions:
- Stabilisation of the head of the humerus in the articular socket of the scapula.
- Movement control for arm elevation and rotation.
- Protects the joint from dislocation under stress.

__Why is this important in rehabilitation? Rotator cuff after shoulder endoprosthesis:
- Requires gentle loading for the first 6-8 weeks (risk of tears)
- Needs gradual strengthening to prevent instability of the prosthesis.
- Affects recovery of proprioception (sense of joint position).

Failure to adhere to the physiological timing of shoulder rehabilitation has specific complications.

Too early active movements (especially rotational movements) can lead to instability of the prosthesis or even dislocation.

Prolonged immobility causes adhesive capsulitis (‘frozen shoulder’), which significantly prolongs the recovery process and can lead to permanent restriction of mobility.

Three-module programme of rehabilitation after joint endoprosthesis¶

For complex recovery after endoprosthesis, our centre uses a three-level rehabilitation system taking into account the physiological features of each joint.

(Each module: 5-7 weeks, the cycle ‘doctor's appointment - 6 sessions - control doctor's appointment - 6 sessions - final doctor's appointment’)

Module 1: Decompression and Adaptation¶

Goal

To relieve postoperative oedema, normalise lymph flow, restore primary mobility without risk of damage to the prosthesis.

Joint specifics:¶

Hip:
- Decompression traction on an anti-gravity simulator
- Myofascial release of gluteal and lumbar muscles
- Passive development with limitation of flexion angle ≤90°.
Knee:
- Lymphatic drainage techniques to reduce postoperative oedema
- Neuromuscular activation of the quadriceps muscle with biofeedback.
- Gentle mobilisation of the patella
Shoulder:
- Postisometric relaxation of the rotator cuff
- Decompression hangs with support
- Breathing exercises for the prevention of shoulder and scapular syndrome

Why 5-7 weeks?

21 days is the minimum time for the primary capsule to form around the prosthesis.
35-42 days - period of adaptation of the nervous system to the new joint.
6 weeks - primary osseointegration of the prosthesis components.

Check-up with the doctor:¶

Assessment of pain syndrome by VAS
Measurement of the volume of movement with a goniometer
Ultrasound control of periarticular tissues condition
Prosthesis stability test

Module 2. Restoring biomechanics¶

Goal

Normalise muscle balance, restore proprioception, eliminate compensatory misalignments.

Features on joints:¶

Hip:
- Stabilisation exercises on balance platforms
- Step-by-step activation of the gluteus medius muscle.
- Limb length correction as needed
Knee:
- Neuromuscular training with visual monitoring
- Restoration of walking pattern with special techniques
- Proprioception exercises with unstable surfaces.
Shoulder:
- Gradual activation of the rotator cuff
- Restoration of scapulothoracic rhythm.
- Kinesiotaping for correction of muscle imbalances.

Physiology

To form a new motor stereotype requires: - 300-500 repetitions for initial consolidation - 3000-5000 repetitions for automation - 6-8 weeks to reorganise neuromuscular connections.

Doctor's check-up:¶

Computerised gait analysis (for TBS and knee)
Electromyography of muscle activity
Scapulothoracic rhythm assessment (for shoulder)
Proprioception test

Module 3. Functional Integration¶

Goal

To regain full range of motion, to prepare for everyday activities, to create a long-term preventive effect.

Features on joints:¶

Hip:
- Simulation of household movements (climbing stairs, getting up from a chair)
- Gluteal muscle endurance training
- Teaching the rules of ‘new biomechanics’ to prolong the life of the prosthesis.
Knee:
- Functional squats with angle control
- Eccentric contractions training
- Self-massage training to prevent contractures.
Shoulder:
- Restoration of full range of motion
- Training of complex co-ordinated actions
- Prevention of adhesive capsulitis.

Results

Restoration of full range of motion in 89% of cases
Absence of pain syndrome in everyday activities
Formation of correct motor stereotypes
Reduction of the risk of wear and tear of the opposite joint by 67%.

Features of our method¶

Individual adaptations:
- For the hip: emphasis on dislocation prevention
- For the knee: control of axial load
- For shoulder: gradual increase in amplitude.
Technological support:
- Biofeedback system for load control
- 3D movement analysis
- Virtual simulators to restore coordination
Physiological rationale:
- Consideration of the timing of osseointegration (12 weeks for complete)
- Gradual increase in load corresponds to regeneration phases.
- Cyclicality corresponds to periods of muscular adaptation.
Prevention of complications:
- For the hip: teaching the ‘90° rule’
- For knee: control of oedema
- For shoulder: prevention of instability

Rehabilitation after ankle arthroplasty and other complex cases¶

1. Recovery of ankle and proprioception after surgery¶

For patients with Ankle Endoprosthetics we develop programmes that combine:

Balance platform training with biofeedback
Tactile pathways of varying difficulty to restore sensation to the foot.
Dosed loading with flexion/extension angle control.

We pay special attention to correction of foot rollover and prevention of valgus/varus deformities, which often cause premature wear of the prosthesis.

Valgus/Varus

Valgus deformity (X-shaped)

Imagine that a person is standing upright, but their knees are touching and their ankles are spread apart - this is valgus. __Feet resemble the letter ‘X.

Feet: Flat, the arch ‘flops’ inward, and the big toe bone protrudes (the famous ‘bump’).
Who is at risk? Women (due to wider pelvis), overweight people, high heel wearers.

Varus deformity (O-shaped)

Now imagine a ‘wheel’ leg - where there is a large gap between the knees and the feet are facing outwards. __The feet resemble the letter O. __

Feet: Outer edge is stressed, arch is too high.
Who is at risk? Children (often congenital), men, overloaded athletes.

2. Rehabilitation of elbow and rotational movements¶

After elbow replacement at our centre:

We use adaptive resistance training machines to safely restore rotational movements
We gradually increase the amplitude without the risk of dislocation of the endoprosthesis.
We use kinesiotaping to relieve the ligamentous apparatus.

The key point is the synchronised development of the humeral and brachial joints, as their dysfunction often leads to overloading of the prosthesis.

Specialised programmes for small joints and complex cases¶

1. Rehabilitation of the hand and fine motor skills after prosthetics¶

For rehabilitation of the hand joints we offer:

Micro-motor therapy with elastic expanders of different stiffnesses
Sensory simulators to restore tactile sensitivity
VR scenarios with imitation of everyday activities (holding objects, buttoning buttons).

Particularly effective methods of preventing scar contractures, often occurring after operations on small joints.

2. Complex approach in polyarthritis and systemic diseases¶

For patients with multiple arthroplasties:

We perform a complete biomechanical analysis of the entire kinematic chain
We develop individualised loads to suit all joints.
We use robotic simulators for dosed development.

The main principle is not just to repair a single joint, but to create a balanced system of movement that prevents overloading other parts.

Full joint rehabilitation at our centre: restoring mobility and joy of movement¶

Rehabilitation is the most important stage after endoprosthetic joint replacement surgery.

In our centre we have created all conditions for the most effective recovery. Modern equipment, individual approach and many years of experience of our specialists help our patients to quickly return to active life.

Unique training equipment for joint rehabilitation¶

In our arsenal - the best rehabilitation equipment that meets the latest international standards:

Vertical and horizontal exercise bikes with adjustable load.
- Smooth pedalling with no shock load on joints
- Adjustable resistance settings for gradual increase in intensity
- Suitable for early rehabilitation after knee and hip surgeries.
- Anatomical body position reduces stress on the spine and joints
Automated Complexes
- Computerised load control
- Safe development of shoulder and elbow joints.
- Precise control of movement amplitude
Specialised lower limb supports
- Help to ‘wake up’ muscles after prolonged immobilisation.
- Particularly effective for rehabilitation of knee joints
- Allows faster restoration of a natural gait
Biofeedback Systems
- Load visualisation on the monitor
- Precise force dosage
- Prevent joint overload

Why choose our centre?¶

Individual programmes
We develop a personalised rehabilitation plan for each patient, taking into account:
- Type of surgery
- Age and physical fitness
- Co-existing medical conditions
Expert Team
We will work with you:
- Rehabilitation physicians
- Therapeutic exercises instructors with medical education
- Physiotherapists
Comfortable conditions
- Spacious halls
- Latest equipment
- Friendly atmosphere
Monitoring at all stages
- Regular check-ups with the doctor
- Adjustment of the programme
- Objective evaluation of progress

How do I start rehabilitation?¶

Make an appointment for an initial consultation
Have a diagnostic evaluation with our specialist
Get a personalised recovery programme
Start training under the supervision of experienced instructors

Do not postpone rehabilitation!

The sooner you start rehabilitation, the sooner you will return to a full life without pain and limitations.