Q: Help me out here. My 82-year-old mother just had a knee replacement. The physiotherapist came in (he looks all of 12-years-old) and is insisting she move that leg and get up out of bed. She is in terrible pain and wasn't all that spry before surgery. Should I say something or just stay out of it? I don't know what to do!

A: Studies show that fewer days in the hospital after a total knee replacement usually means lower costs. And one way to accomplish that is to begin physiotherapy within the first 24 hours after surgery. Many surgeons are going in this direction. Your mother's surgeon may have written orders for physiotherapy to begin immediately.

As a member of the rehab team, the therapist may be following a prescribed protocol based on best-evidence available from studies. Getting patients up and moving after total knee replacement is considered the best postoperative approach.

The longer the delays and the more days in the hospital, the slower the recovery and the greater the costs associated with the procedure. Physiotherapy to initiate therapy as early as possible is recommended -- both for the patient's benefit and for a cost-savings measure.

But as anyone working patients who have had a total knee replacement knows, not all patients are created equally. There are some who are ready and eager for an exercise program and immediate activity (on day one after surgery).

But there are others who are very slow to move the leg and get out of bed much less make themselves contract muscles and flex and bend the knee. Sometimes the pain (or perception of pain) is just too great in their minds to move smoothly or often.

There are other risk factors that might work against some patients following knee replacement surgery. For example, the patient's state of mind (i.e., mental health) is an important factor. Depression, low self-esteem, anxiety, and fear can interfere with rehab progress.

Getting started and progressing quickly through the program can be a major challenge for some people after a knee replacement. The type of implant used, the way it fits (or doesn't fit) inside the joint, and even specific surgical technique can result in postoperative complications and problems, including failure of the implant.

Your mother may actually surprise you and herself by complying with this young man who does seem to know what he is doing. Unless you think your mother is in some kind of physical danger, it may be best to take a back seat for a bit and see how this works itself out. Your mother may even do better if family members aren't present. If no one is there to offer sympathy or a way out, she may just step up and surprise everyone, including herself!

Reference: Labraca NS, et al. Starting Rehabilitation Within 24 Hours After Total Knee Arthroplasty Was Better Than Delaying to Within 48 to 72 Hours. In The Journal of Bone and Joint Surgery. February 15, 2012. Vol. 94-A. No. 4. Pp. 366.

In Balance Physiotherapy provides services for physiotherapy in Toronto.