OT: Post knee replacement questions where please?

[John Rumm]

version of it anyway)

[T i m]

Ah, um, no, I'm not even going to ask when / where and on what they used one of those!

All the best and thanks (I think) ;-)

T i m

[chris]

No problems - my email is valid at the moment if you want to contact.

I could fully straighten and lock my knee after about three months.

No I don't regret having it done as the pain I was in before was driving me to distraction and more and even what it was like just after the op was better than before.

Apologies for the delay in getting back but I've been over in Gloucester helping the son out.

Chris

[Ian White]

Sorry to join this thread late, but what advice have the hospital given about exercises *between* visits?

Pooling the good advice given to three people (one of them myself), covering four hips and two knees, the key to recovery is to exercise lightly but regularly at home, at least twice a day, EVERY DAY. No exceptions, no distractions - no phone, no radio, no TV, no T i m even - just total concentration on covering the whole range of movement at exactly the right pace. Again and again and again and again...

Then there's the pain, of course. This is not going to be comfortable in any way, but her attitude can make a huge difference. It's a very personal thing, but I always try to see the difference between unwanted pain that I cannot control, and a moderate level of 'good pain' that I'm deliberately choosing to put myself through because it's going to do me good.

The aim of the exercises is to gently but persistently stretch muscles and break down adhesions that will permanently limit movement if they are allowed to persist. The exercises can be expected to hurt while you're doing them, but not afterwards.

The role of the hospital visits is then for the physiotherapist to provide the exercises, work out ways to do them at home (which is where DIY ingenuity comes in), rehearse them to make sure she knows how to do them properly, and then keep checking on that. I am not an expert, but would be fairly suspicious of exercises that allow the knee movement to be forced by body-weight and/or some other part of the body (eg an exercise bike). All the hip exercises I was given were based on letting the recovering muscles do their own work; a few experiments with an exercise bike were unsuccessful because they did tend to force things in the wrong way.

Another important thing is to *tell* the physio that she's aiming for a complete recovery, and is ready to do whatever it takes. This includes granting advance permission for the physio to be rude and ruthless when she starts to slack off - which she naturally will, as recovery progresses and boredom sets in. This is one area where the patient really can't help herself, but the recovery process isn't complete yet, so it's very important for the physio to step in to keep the motivation going.

Also remember that physiotherapists enjoy some motivation themselves - they *like* having patients who are dedicated to making a good recovery.

In other words, this thing needs to own her whole life for several weeks

- for these first weeks are crucial for the long-term recovery. Things can be done now that can never be done later. Once she can do normal activities in a way that isn't limited by pain, those activities will take over from the exercises and will very slowly continue to improve the range of motion.

The whole process will also drive her mad - but if the op was good in the first place, she may be able to *run* after you with an axe. Now wouldn't that be nice?

[T i m]

Hi Ian and better late than never! ;-) Apparently it started off, quite simply and they have added more each visit.

Ok. Well, she's doing all the combinations at least 4 times a day and has added extra ones (like using her exercise bike gently on no load) to enhance those movements that see feels need special attention (like the 90 deg threshold).

The actual exercises:

Sitting on a high stool and bending her leg back by it's own muscles.

Standing at the bottom of the stairs with the new knee on the first step and 'flexing' against maximum deflection.

Standing with the new knee bent behind her and pulling up behind her with a towel looped under the same calf.

Leaning over a high stool and squatting with the legs (weight on upper body / stool).

Sitting on the bed / floor and pushing down to straighten.

Adopting the sprint start with new knee out straight behind her and trying to lock the leg out.

Standing at the bottom of the stairs with heel of new leg on the first step and pushing the knee down (this gives her other pains in the side of the new joint though).

One of the 'issues' that may affect her more than typically 'skinnier' older folk having the same op is the fact that she's quite 'muscley? It was explained that is it easier to do the op on older people with (typically) older / weaker / smaller muscles that don;t need so much effort to get out of the way during the op?

When she's had the physio she has been told all her muscles around the joint are 'solid' and much of the physo is spent working (massage / pummeling) trying to loosen them all up?

The other question she has for you Ian is did any of your poll suffer sensitivity loss in the foot? She 'still' (6 weeks today) doesn't have full feeling in 2/3rds of her foot (so toes / ball of her foot is ok but heel and much of the instep is nearly 'dead'). Also the outside of her foot (from little toe back to heel) is numb / pins_and_needles, inside is ok? Similar with areas over her knee.

Question from us. What is it that actually stops the movement in the new knee please Ian? Is it a metal 'stop' (like a car door) or simply muscles / tendons that are at limit?

(I'm used to that) ;-(

Ok ..

Well she's off all the painkillers now (nearly a week) so can feel right enough when she's getting near the 'edge'. Like I've said before she's a tough old girl (high threshold of pain) and was clay shooting with her staples still in from a tennis elbow a while back .. ;-(

Understood .. I've had to judge the angle of her knee bend many times so know when she's doing the 'no pain no gain' thing.

She nodded when I read that bit out Ian. At the first physio session it was mentioned that a muscle was stuck to her patella and she was massaged fairly 'deeply' (laughing and crying) and felt much better afterwards ... well for about 15 mins?

Understood.

Hmm, some of the exercises given by the hospital seem to involve pushing quite hard against the (90 deg) angle but not put her weight on the joint. She was asked to 'test' the ability to do some revolutions on an exercise bike at the physio session.

Understood.

Good idea. We are going again today so I'll suggest she puts that across.

Luckily my Missus isn't like that (letting off), in spite of having some bad / depressed days when she feels she's not making any progress.

Understood, and loss of movement range is one of the things that is driving her on. Doing our own poll of ex knee jobs it seems '90 deg' is not uncommon as a final maximum deflection?

I'm pretty sure that would be considered the case in this case Ian. She doesn't seem to be sitting still for many mins (although she has to as the exercises are quite tiring) before she's up and doing some more. Yesterday we walked to the-top-of-the-road and back (it's flat and about .3 of a mile) and although the new knee was ok it put extra load on her old (and also bad) knee and (bad) back, meaning she had to sit a couple of times at the top.

The main focus for her at the moment Ian is the total deflection. She can get it to about 3 deg of straight and 90 bent. Not being actually dead straight means she can't lock her leg / knee out so standing on it is difficult.

Yes! However, she's still at the 'I wish I hadn't had it done' stage, not for the pain but for the restricted movement that she predicts are going to stop her doing those 'normal' things, things she could still actually do pre op but with loads of grating noises and pain. ;-(

All the best and thanks very much for your time / trouble etc.

T i m & Sue.

[T i m]

Ok.

Hey, no probs Chris. I hope he wasn't affected too badly?

All the best ..

T i m