Dr Andrew Wickline in the USA has advocated a home therapy protocol which is designed to empower patients to take control of their recovery after joint replacement surgery. The key to success is early movement, consistency, and patient engagement. Here’s a step-by-step guide on how to follow it effectively:
Start early
- Begin walking and basic exercises within hours of surgery (often the same day).
- This early mobilisation helps reduce pain, prevent blood clots, and improve overall recovery speed.
Walk frequently
- Walk very 1–2 hours during the day, starting with short distances and increasing gradually.
- Indoors at first, progressing to outdoor walks as tolerated.
- Aim for natural walking patterns — heel-to-toe steps, upright posture, and symmetrical stride.
- Step count
- Week 1 – do not exceed 1000 steps per day
- week 2 – do not exceed 1500 steps per day
- week 3 – do not exceed 2000 steps per day
- week 4 – do not exceed 2500 steps per day
Perform specific exercises
THE EXERCISES SHOULD ONLY TAKE 5-10 MINUTES PER HOUR – FOR THE REST OF THE HOUR ELEVATE THE LEG
For Knee Replacement:
- Heel Extension Hang: Sit with heel supported on a chair in front of you and your knee unsupported to encourage full extension – allow gravity to help straighten the knee. Hold this for 5 minutes – REPEAT 3 X PER DAY
- Heel Slides: Sit on a chair – Slide your heel toward your body to gradually improve knee bend.
- Quad Sets: Tighten your thigh muscle, hold for 5 seconds, repeat 10x. once an hour while awake
- Calf pumps: point toes down to floor – like pressing on a brake paddle in car – hold for 2 seconds, repeat 10 times, once an hour while awake
For Hip Replacement:
- Glute Squeezes & Quad Sets: Activate core hip muscles early.
- Heel Slides: Gently bend the hip and knee in a controlled way.
- Bridging: Lift hips from lying position to build strength.
- Abduction (Side Leg Raises): When cleared, gently lift the leg out to the side.
Manage pain & swelling
- Use ice packs or ice machine 3–5 times per day for 20–30 minutes.
- Elevate the leg (especially after walking) to reduce swelling. toes above the heart for THE first 2 weeks when not exercising
- Take non-opioid medications (NSAIDs, paracetamol) as prescribed.
Be consistent
- Do short, frequent sessions rather than long, intense workouts.
- Follow the programme daily — consistency leads to faster, safer recovery.
- Keep track of progress (range of motion, walking time, pain levels).
Understand and own your recovery
- Read all pre-op materials and watch instructional videos if provided.
- Know that formal outpatient physiotherapy is usually not needed unless specific issues arise.
- Contact your care team if pain is unmanageable or progress stalls.
With proper commitment, most patients on this protocol walk unassisted within 1–2 weeks and resume normal daily activities by 4–6 weeks — often with minimal to no physiotherapy visits and low pain medication use.