Total joint arthroplasty: principles and guidelines for postoperative physiatric management.

Postoperative physiatric treatment is an integral part of the replacement of hips, knees, ankles, shoulders, elbows, wrists, and digital joints. Neuromuscular substitution patterns and incoordination usually prevail after joint replacement because of the usual long-term expectation and experience of pain, limitation of motion, fatigue, weakness, and the unavoidable operative trauma. The goals of postoperative physiatric treatment, in line with those of joint replacement surgery, are relief of pain and reestablishment of comfortable, normal neuromuscular functions and their reasonable, safe application in appropriate activities of daily living and of locomotion. By close collaboration between the Department of Orthopedic Surgery and that of Physical Medicine and Rehabilitation, certain principles and detailed protocols of postoperative management have been developed over the last 10 years. These are described in some detail for each of the joint replacements. Optimal results can be achieved only through meticulous attention to physical and psychosocial details, with close cooperation and communication among the involved services and persons.