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Medical Forum / Diseases and Disorders / Arthritis / November 2006Knee Replacement - Post Op Observations
I had a Total Knee Replacement of my right knee operation on 21st August and wonder if anyone can help me with a couple of points. Firstly, although the op was successful and, although I am walking well with crutches (and for a few steps with no aid at all), when sitting I still cannot yet achieve a 90 degree bend - only about 75 degrees being possible because of pain and restriction from the surrounding tissues (not the joint, of course!). Secondly, the operated leg from the knee down to the toes is considerably swollen (not painful) and I am wondering whether when this reduces I will be able to achieve 90 degs or more bend. I am applying cold compresses to the knee which has reduced the swelling there but the skin on the ankle and lower leg is still 'tight'. As the op was only three weeks ago, am I being impatient? Will I be able to achieve the 90 degree bend in time? When may I expect the swelling to go down? Your help would be appreciated. Regards, Chris (Dorset) >I had a Total Knee Replacement of my right knee operation on 21st > August and wonder if anyone can help me with a couple of points. [quoted text clipped - 20 lines] > > Regards, Chris (Dorset) I've had three knee replacements, and yes, I think you are being a little impatient Chris. Firstly, you shouldn't be walking without crutches at all so soon after the operation when the knee is still swollen. After all, the joint needs time to get over what the surgeon did to it, and that's what the crutches are for. They are meant to stop you weight-bearing after the operation - ie supporting you while you're walking during the first six weeks at least. I would suggest trying one crutch after about 5 weeks or so to give yourself the best chance of a normal recovery. You should have been referred to a physio on a regular basis, and you should be doing the same knee bending exercises several times a day at home too, and lying on top of the bed so you're non-weight bearing. Your physio or GP will always answer questions you have, and I presume you'll be having a 6 week post-op meeting with your surgeon? I'm sure the 75 degrees range of movement (ROM) will improve to 90 - 100, as long as you listen to your physio and do as you're told lol. The swelling will reduce, and if not, blood tests can always be done to find out if the swelling is caused by an infection. Be patient, and don't try to run before you can walk (for want of a better expression) Post again if you have any more questions, and report on how you're doing? Splodge Splodge - Thank you very much for coming back to me so quickly and offering advice from your experiences. Your comments about crutches differ somewhat from what my physio has told me. She has said that I can use one if I feel OK about it (which I do) and I gather the consultant will expect me to walk unaided into his surgery at my post-op checkup which is five and a half weeks after the op (29th Sept). No connection has been made by physio between the use of crutches while the swelling is present. They have said that the swelling is quite usual and should go down after a couple of months or so. The knee swelling is considerably less now, but the skin on my ankle and calf area feel very tightly stretched, making walking more difficult. I don't think the swelling is an infection though. I am wearing DVT stockings, of course. Regarding the "ROM", I am having physio twice a week at the hospital and they are trying to 'encourage' more ROM by, in the sitting position on a raised surface, forcing my lower leg to bend further. Even with drugs (Tramadol) this is extremely painful but seems to be what is necessary as each time I manage a few more degrees. Two questions: 1) What is causing the 'obstruction to movement'? (It obviously can't be the new joint) and, 2) When I achieve full ROM, will I have to keep up some sort of similar exercise routine to maintain it, or will it self-maintain through daily use? Thank you again for your helpful comments. Chris (in Dorset) > I've had three knee replacements, and yes, I think you are being a little > impatient Chris. Firstly, you shouldn't be walking without crutches at all [quoted text clipped - 19 lines] > Post again if you have any more questions, and report on how you're doing? > Splodge > Regarding the "ROM", I am having physio twice a week at the hospital > and they are trying to 'encourage' more ROM by, in the sitting position [quoted text clipped - 8 lines] > > Thank you again for your helpful comments. I had a feeling that some of my reply could be a bit out-of-date by now, Chris, as I had my knee replacements done in 1998, 1999 and 2000. It would seem the surgeon is more optimistic for a speedy recovery than in my day, and it doesn't sound like your physio is bothered about the knee swelling or the tightness in the ankle and calf. The knee would feel very hot to the touch if it was an infection, so that's another worry out of the way. I would say to carry on doing as you're told. Deciding whether to take painkillers before or after the physio could be a problem! Unfortunately three knee replacements doesn't make me an expert, as I'm the most untechnically-minded person there is. My guess is the "obstruction to movement" is plain old internal bruising and swelling from the operation. After all, a lot of chiselling and bashing about goes on during the op. I had bruises for weeks afterwards. I kept on doing physio at home to get my full ROM, although I didn't have to go to work. (And I haven't even mentioned getting my hips and shoulders done!!) Be patient, it will get start getting better soon - if you can find a happy medium between too much and too little physio. Splodge Hi Chris I'm jumping in a bit late here, but just a quick comment about crutches. I think it must differ for different people / different areas. I had a walker for the first day in hospital, and then graduated to two sticks in the ward, and to take home. Another difference is that in the hospital where I was operated on, we didn't get to wear the lovely stockings either, which was a relief! After the 3rd day, the wound dressing was removed and the whole thing left exposed. It healed wonderfully and I have a fairly neat scar. Once the skin healed, I found that using wheatgerm oil was good for the scar tissue (or any oil rich in vit. E apparently). I think it was about the 3 week mark that I was using one stick, and using none in the kitchen etc (just holding the countertops). My leg was swollen for ages - in fact when I measured my calf (on buying a pair of boots in December) the operated leg was still a bit bigger. It has been 18 months for me now, and I think it is back to normal. The "tightness" of the surrounding tissues does impede the ROM a bit, but I think they pushed physio/physio/physio on me after hospital. Everyone else on the ward was able to do straight leg raises the day they went home, but I could barely manage a centimetre (but then everyone else on the ward had had partial replacements I later found out!). For about 3 months I used to wonder about people who raved about how wonderful their replacement was, as I thought mine was the pits - I couldn't sleep properly for weeks, it "clunked" when I walked. They told me at the follow up visit it would continue improving for a year, and in my experience it did - I got to the 1st anniversary and realised that we were "there", thinking as others had told me, that my replacement was at last, wonderful! I wish you all the very best with your knee, and long may it continue to get better! Jayne Hi Jayne & Splodge - I have "lurked" in this Group for some while, knowing that I was likely to have to have one (and possibly later the other) knee replaced and have noticed previous postings from both of you. It is good of you to answer MY postings now! So I am most grateful to you both for letting me share your experiences and thoughts regarding recovery time, what to expect when, etc. It seems that there are so many variables according to such things as the hospital, the surgeon, the physiotherapist, the patient's physique before and after the operation etc. etc. It is therefore understandably difficult to gauge whether one's recovery progress is normal or not. I gather that recovery time for a total knee replacement can go into months - even years - and it is considered perhaps the longest for any operation. Of particular interest to me is whether when the swelling goes down I shall be able to bend my knee more than the 75 degrees I have now or whether, with the help of the physio, I should be made to push through the pain barrier before the swelling goes down in order to achieve the eventual bend required to do some gentle cycling as well as drive my car. Thanks again, Chris (in Dorset) > Hi Chris > [quoted text clipped - 32 lines] > > Jayne > Hi Jayne & Splodge - > [quoted text clipped - 25 lines] > > Chris (in Dorset) Admitedly it has been 18 months since my op, but I have been going well past 90 degrees for about a year now. I saw my surgeon today funnily enough, as a follow up to an arthroscopy I had done on my right knee 6 weeks ago, and he was well impressed with the bend I could get. I think when I was at the stage that you are 75 degrees would be about the same for me. The only bugbear is I wish I could kneel on it - I can't even kneel on my son's bed in order to lean across to shut his window. Keep up the physio - you will get there! Oh, and my good bit of news - for the next knee op I will be able to get away with just having a partial replacement rather than the total one. Jayne >snip > Oh, and my good bit of news - for the next knee op I will be able to get > away with just having a partial replacement rather than the total one. That's brilliant news Jayne. Have you got a date for the op yet? Or a rough idea when it will be? Splodge > That's brilliant news Jayne. Have you got a date for the op yet? Or a > rough > idea when it will be? > Splodge Hiya! No firm date - I went to the hospital yesterday and got to see some nice colour photos of the inside of my knee! Its not as bad as the left one was - they did some debridement of the cartilage on the outside edge, but the cartilage on the inside edge is getting thin. As the cruciate ligaments are intact they can get away with the partial apparently. (the left one had gone way too far and was bone on bone, with about 1/2 inch worn away on one side). Anyway, I got the usual "you're quite young" etc etc, and agreed to wait another 6 months as I am. When I go back in spring we will do more x-rays and then I will go on the list. All in all it will be about this time next year. I can live with that - I don't need to walk with a stick now, as the left one is so good, and only limp a bit when I've done a lot of walking. The pain is nothing like as bad as it was before the first one was done. Jayne >> That's brilliant news Jayne. Have you got a date for the op yet? Or a >> rough [quoted text clipped - 18 lines] > walking. The pain is nothing like as bad as it was before the first one > was done. I got the "you're quite young" bit when I desperately need my right hip doing. I was 40, but walked like an 80 year old. Luckily I was able to change areas and got it done within 6 months. I think it's a lot easier to pick a different hospital now, but it wasn't then. (1987) Splodge > I got the "you're quite young" bit when I desperately need my right hip > doing. I was 40, but walked like an 80 year old. Luckily I was able to > change areas and got it done within 6 months. I think it's a lot easier to > pick a different hospital now, but it wasn't then. (1987) > Splodge My surgeon is more pragmatic about it - his view is that yes, I am young(ish) to have it done, but it is necessary so no good whinging about it. Unfortunately his registrar isn't. When he started at my last appointment, by saying that I shouldn't have been given the left one as I am "much too young", and was quite stroppy about it. I mentioned this to the surgeon when I saw him in July. I don't know if it is coincidence, but this appointment with the registrar he was just fine! Jayne Hi Jayne - What a nice optimistic message! Both for me and for you! I am reassured that you had about 75 degrees at the same stage as me (three and a half weeks from the op) - did the rest come gradually as the swelling went down? I agree about the drawback of not being able to kneel on the operated leg. Excellent news re your future half knee replacement. Please tell me the pros and cons of a half knee as my other leg will have to be attended to in perhaps a couple of years' time. How does one 'qualify' for a half knee replacement? Are they as good as whole knee replacements? Thanks again for your views on all this. Regards, Chris (in Dorset) > > Hi Jayne & Splodge - > > [quoted text clipped - 40 lines] > > Jayne > Hi Jayne - > [quoted text clipped - 14 lines] > > Regards, Chris (in Dorset) Hi Chris - it was quite gradual. One of those situations where I was struggling with physio and thinking "this will never be right", and then some weeks later realising it was really beginning to get there! I wish I had kept a diary so I could remember properly, but it is good now. The gen on the partial, as I remember: their criteria is that the knee mustn't be rheumatoid, the cruciate ligaments should be intact and in fairly good nick, and they only do it on the inside half of the knee, not the outside. It is less of an op than the total replacement, and gives a bit of scope / time if you are a younger patient. I remember from a year or so ago, if you do a search on "oxford knee replacement" or "unicompartmental knee replacement" you will find loads of info - far better than my limited offerings! jayne Hi Jayne - > it was quite gradual. One of those situations where I was > struggling with physio and thinking "this will never be right", and then > some weeks later realising it was really beginning to get there! I wish I > had kept a diary so I could remember properly, but it is good now. That's exactly how I am feeling right now after having almost daily improvements in terms of degrees of movement, I seem to have 'stuck' at 75-80 degrees as if there's a sort of 'block' there. Like you, I've been thinking "will this ever be right enough for me to drive and even cycle again?" So, from what you say, things should improve some weeks hence - is this by continuing my painful "trying to force it further regime" or by resting from physio when the swelling will hopefully go down too? > The gen on the partial, as I remember: their criteria is that the knee > mustn't be rheumatoid, the cruciate ligaments should be intact and in fairly [quoted text clipped - 4 lines] > knee replacement" you will find loads of info - far better than my limited > offerings! Thanks for that, Jayne. I think my other leg may qualify as the wear is most certainly on the inside and is osteo. I think the ligaments are in good nick too. What life span can one expect from a half knee? And what recovery time? Chris (In Dorset) > That's exactly how I am feeling right now after having almost daily > improvements in terms of degrees of movement, I seem to have 'stuck' at [quoted text clipped - 4 lines] > regime" or by resting from physio when the swelling will hopefully go > down too? I can't comment on that really Chris, as I think you should take advice from someone qualified (perhaps your physio?). You may do damage by forcing it - I know I didn't force anything, just plugged away at the exercises. I was shocked by how weak my muscles were afterwards, and it seemed to take ages to strengthen them. > Thanks for that, Jayne. I think my other leg may qualify as the wear > is most certainly on the inside and is osteo. I think the ligaments are > in good nick too. What life span can one expect from a half knee? And > what recovery time? >> > Chris (In Dorset) I don't know the life-span I'm afraid, but I believe it is good. From what I've read the best thing about it is that it puts off the total replacement for a number of years. Jayne Thanks for your further views, Jayne. The physio today started talking about having my knee 'manipulated' under anasthetic if I can't get it to bend more than 75 degrees after four months. But then said that, as I'd only had one month since my op, not to worry about this! So I won't - especially as I am now walking unaided rather well. Hopefully I will gain more bend with time. Regards, Chris (in Dorset) > > That's exactly how I am feeling right now after having almost daily > > improvements in terms of degrees of movement, I seem to have 'stuck' at [quoted text clipped - 23 lines] > > Jayne Ouch - that doesn't sound very nice Chris, but I have heard that they do sometimes do that, if internal scar tissue is causing things to stick. However, one month is still very early days - I wasn't sleeping at all well at that stage and muscle weakness was still a major issue for me then. Keep trying your exercises, and do your bends little and often. I bet you will be surprised when one day you just realise that you can do it! Jayne > Thanks for your further views, Jayne. > The physio today started talking about having my knee 'manipulated' [quoted text clipped - 7 lines] > > Chris (in Dorset) Thanks for your encouragement, Jayne. I am to have my post-op follow up consultation with the surgeon next Friday (29 Sept), which will be five and a half weeks. I'll report back as to what he says ... Thanks again, Chris (in Dorset) > Ouch - that doesn't sound very nice Chris, but I have heard that they do > sometimes do that, if internal scar tissue is causing things to stick. [quoted text clipped - 18 lines] > > > > Chris (in Dorset) As promised, I'm reporting back after seeing the consultant surgeon this morning. It is almost six weeks since surgery. There was good news and bad news:- The good news was that he was pleased to see me walking more or less normally, unaided by crutches or sticks. The bad news was that he was very concerned that I still could not achieve a ROM in excess of about 75 degrees, despite much physiotherapy and exercises at home. His solution: He wants me to come back into hospital a week on Monday (9th Oct) for two days for manipulation under anaesthetic followed by intensive use of the CPM machine. After that he says he wants me to be able to ride a bike! He said that only about 1% of his TKR patients have to have post-operative manipulation! He does "about one a year" he says. I wonder why I have drawn the short straw! Does anyone know how permanent the ROM achieved after manipulation is - or any other facts or first hand experiences of it? I would be most grateful for your views. Chris (in Dorset) > Thanks for your encouragement, Jayne. I am to have my post-op follow > up consultation with the surgeon next Friday (29 Sept), which will be [quoted text clipped - 23 lines] > > > > > > Chris (in Dorset) > His solution: He wants me to come back into hospital a week on Monday > (9th Oct) for two days for manipulation under anaesthetic followed by [quoted text clipped - 6 lines] > I would be most grateful for your views. > Chris (in Dorset) I must have drawn several short straws then Chris, but please remember that about 95% of knee replacements are perfectly fine. I was just very unlucky. I had my left knee replaced in Sept 1998, then I had a Manipulation under anaesthetic (MUA) in Nov 1998, which resulted in a very small increase in ROM. I had another MUA the following month and this time there was a dramaticand permanent improvement in ROM to about 90 - 100 degrees. After both MUAs I had extensive use of the CPM machine. Normally you lie on top of the bed and they set the % level the machine bends your knee. It's quite painless as the machine does all the work for you. But as you're "pinned" to the machine, take lots of stuff to read. I was really unlucky in that in my case an increased ROM caused additional problems and I needed to have the complete knee replaced twice more after that - in April 1999 and finally in May 2000. I also received a full depth burn on my leg during the first revision and needed a skin graft, but that's another story as I then had to sue my surgeon for medical negligence lol. I'm sure your MUA will be fine and you'll soon be skipping around again. Splodge Hi Splodge - My goodness, you WERE unlucky! I'm going into this MUA in a fairly laid-back sort of way - I hope my relaxed attitude is justified and that the increased ROM from my already useful (for walking) 75 degrees up to 90 or 110 will enable me to drive and, hopefully, cycle again. So two questions remain: 1) What determines whether the increased ROM after MUA will be maintained? 2) What was the reason for my lower than expected initial ROM? This is important to me as, if it is to do with my physiology (eg producing excessive scar tissue), would I be right in anticipating similar problems when I have a TKR on my other (left) knee a year or two hence? Again thank you for your views. Chris > I must have drawn several short straws then Chris, but please remember that > about 95% of knee replacements are perfectly fine. I was just very unlucky. [quoted text clipped - 17 lines] > I'm sure your MUA will be fine and you'll soon be skipping around again. > Splodge > Hi Splodge - > My goodness, you WERE unlucky! [quoted text clipped - 11 lines] > Again thank you for your views. > Chris I'll do my best, briefly, but I'm not sure I'm the best person to ask. 1) Answer - whether the surgeon does his job properly and if the patients does the physio often and correctly are my first thoughts. 2) I've spent a long time wondering why my right hip was done in 1987 and is still fine nearly 20 years on, but the left one was done in Aug 2004 and it dislocated before I even left hospital. After that I was rushed back in with another dislocation so it was reset, then followed 8 - 10 partial dislocations before it was completely re-done again. So how can anyone explain that? (It was a different surgeon). And before you ask, I wasn't doing anything stupid. Every patient is different, there are new prostheses being designed and inserted each year etc., so maybe you should be asking your surgeon on Monday exactly why he is doing an MUA, ie what does he think the reasons are for your reduced ROM, does he think you'll get the same problems on the other knee? Thinks - best to ask him when he comes round after your MUA lol Passing thought from a female, I had both my MUAs done on a Friday and was back at work the following Monday - unlike two rugby players in my office, who both had one and each took a week of work. Wimps!! Good luck on Monday. Let us know how it goes, Splodge > Good luck on Monday. Let us know how it goes. Thanks, Splodge, I will - should be home Wed after two days of CPM! Chris > > Hi Splodge - > > My goodness, you WERE unlucky! [quoted text clipped - 33 lines] > Good luck on Monday. Let us know how it goes, > Splodge I'm home now after having had the MUA two days ago followed by 48 hours (nights too - didn't get any sleep!) of CPM machine. Hospital excellent. You will recall that I had 75 degrees ROM before the manipulation. The surgeon told me afterwards that he'd achieved 120 degs during the manipulation proceedure and I was getting about 110 max on the CPM yesterday when there was little pain. Today I've been getting pain on the inner side of the knee which came at about 95 degs (and upwards) on the CPM. I'm able to get a fairly easy 90 while sitting, though there's a bit of that pain again even at 90 now. I just hope the pain goes away (painkillers don't seem to work with me) otherwise I am worried that it'll be too painful to use 90 degrees - or will the pain get better with time if I work through it? I don't want to lose the extra ROM gained. Surgeon says that I can drive again as I now have 90 degs and the actual TKR operation was seven weeks ago - so that should be good news! That's my promised update after MUA. Your comments will be very welcome. Regards, Chris (in Dorset) > > Good luck on Monday. Let us know how it goes. > Thanks, Splodge, I will - should be home Wed after two days of CPM! [quoted text clipped - 37 lines] > > Good luck on Monday. Let us know how it goes, > > Splodge That's good news Chris, and I'm sure you'll get the additional ROM without pain if you keep up the physio. But you are talking to someone who needed two MUAs, remember? Hopefully you will only need one, as do most people that need it. And you can probably see why you get a full anaesthetic........ Keep up the hard work, and let us know how it goes Splodge > I'm home now after having had the MUA two days ago followed by 48 hours > (nights too - didn't get any sleep!) of CPM machine. Hospital [quoted text clipped - 74 lines] >> > Good luck on Monday. Let us know how it goes, >> > Splodge Thanks, Splodge, I will. Today started very badly with more of the pain I mentioned above. But then I took a couple of Tramadol tablets and, as if by magic all the sharp pain went, leaving a dull much more manageble pain. This enabled me to get on my exercise bike and very gently complete some pedal turns plus, this afternoon, I was able to drive about six miles with little discomfort apart from when transferring my right (operated) foot from accelerator to brake. Actually the worst part was bending the right knee enough to get into the driving seat. Well the surgeon wanted me to try driving and I did it! >From a poor start, the day worked out well! Chris (in Dorset) > That's good news Chris, and I'm sure you'll get the additional ROM without > pain if you keep up the physio. But you are talking to someone who needed [quoted text clipped - 82 lines] > >> > Good luck on Monday. Let us know how it goes, > >> > Splodge Well done Chris Onwards and upwards. It's nice to see you making progress Splodge > Thanks, Splodge, I will. > [quoted text clipped - 114 lines] >> >> > Good luck on Monday. Let us know how it goes, >> >> > Splodge Another update: It's now 11 weeks since my TKR and 4 weeks since my MUA. All has been going well until last week when I had my last physio session. I was up to then able to go on my exercise bike for about 10 mins of steady exercise and go up and down stairs. However, after the physio session when he kept pressing my knee down (he is concerned that it is still slightly bent when standing), I have been unable to do my exercises (which are important to keep the ROM up to 110 degs). The reason is that the sharp pain on the inside of the knee (mentioned in my earlier postings) has come back. It is VERY painful and has now stopped me from exercising which was coming on well before. What can this sharp pain localised on the inside of the knee be? Is it best to rest it (and risk losing ROM through lack of exercise). I find painkillers don't work for me but, if they did, would it be best to 'work through' this awful pain? What about the application of heat or ice? The good news is that the pain doesn't 'cut in' until about 75 degs bend, so my walking is excellent and unaffected. Your help is appreciated. Chris > That's good news Chris, and I'm sure you'll get the additional ROM without > pain if you keep up the physio. But you are talking to someone who needed [quoted text clipped - 82 lines] > >> > Good luck on Monday. Let us know how it goes, > >> > Splodge |
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