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Knee Operations and Procedures

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Dave Robinson - Personal Story

This is the story of one patients journey along the road of knee problems culminating in knee replacement. The patient is a 60 year old gentleman and commentary is written by Andrew Caldwell, consultant physiotherapist at Active Therapy based at the Lichfield Golf & Country Club and The Chase Golf, Health Club & Spa. It is written 5 months after surgery. Author: Dave Robinson


The build up
Leading up to my total knee replacement due on December 1st 2014, I fully expected to be ‘up and running’ by February 2015. Indeed, I had even contemplated the idea of going skiing in the March.
The history of my knee issues had been present for some time. When I was 20 (40 years ago), I injured my knee badly playing rugby. I needed a lateral meniscectomy (cartilage op) which left me unable to participate in sport for a considerable amount of time. From that time on I was aware that the internal condition of my knee was deteriorating slowly. By the time I was 30 I could no longer participate in contact sports like soccer or rugby, so I focussed on cricket. As I moved into my 40s the condition of my knee had worsened and at times I had to take pain killers to continue playing sport. I continued to ski but this caused me more and more discomfort as the years passed by. Eventually three or four years ago I thought enough is enough, skiing is now becoming too painful. I decided to have the joint cleaned up (arthroscopy and wash out/debridement). I had physiotherapy treatment post-operatively with my physiotherapist Andrew Caldwell and this appeared successful at the time. I returned to regular exercise participation and golf but my symptoms subsequently began to worsen and in consultation with my surgeon Tim Spalding I decided to opt for knee joint replacement (or arthroplasty).
Having had a number of arthroscopic investigations over the years on the other knee as well, I guess I had been lulled into a false sense of security. When it came to the total knee replacement, I thought I’d put a bit of ice on it, do some exercises and be ‘right as rain’ in a few weeks. It was only when somebody told me that a knee replacement operation was major orthopaedic surgery that I began to realise how much more involved this journey would be.

Andrew Caldwell comments:
When electing for orthopaedic procedures such as knee replacement patients need to be advised and understand that arthroplasty (joint replacement) is a significant operation with a very different recovery to arthroscopy (keyhole surgery) requiring intensive post-operative rehabilitation to achieve optimal outcome.


The initial recovery
The operation went very well and without complication. I received excellent care as an in-patient whilst in hospital and could not have been better looked after. I had the procedure on Monday and went home on Thursday. I mastered the crutches quickly, and did all the basic exercises prescribed without any problems. When I was back at home I had been told to carry on with the flexion and extension exercises, take the pain killers to allow more movement to be achieved and then to elevate and ice the knee. I did this for a week and started to feel good about progress.
Eleven days after the op I had the staples (stitches) removed and then a few days later went for my first physio session. At this meeting my knee flexion was 85 degrees and I was still short of being able to extend the knee joint fully. I was a bit frustrated by my lack of progress at this point. I consequently experienced quite a painful session on this first occasion as the Physio encouraged more bend and extension in the joint. It was December 15th. I returned home but with Christmas looming and the family starting to arrive I neglected the exercises, the painkillers and the ice. For two weeks I probably only iced once a day, took no painkillers because I wasn’t really in any pain, and did not commit anywhere near as much time as I should have to my exercise programme.
It was January 5th before I went for my second physio session. My knee flexion was 80 degrees. I had lost 5 degrees of flexion through inactivity! I was also experiencing pain on the medial side of the knee. The physio was a little frustrated by my deterioration. That session was particularly painful as the physio tried to encourage more flexion and extension into a stiffening knee joint. It was impressed upon me to take the painkillers and to ice regularly. The painkillers would help to mask the pain as I did the exercises and to push myself to improve the range of movement. Finally I had got the message! But I had lost 2 – 3 weeks of potential progress due to complacency. I now realised that the only way this would work was if I was prepared to work hard and go through a bit of pain. I started hydro therapy and at the third physio session recorded 90 degrees of flexion. I was now taking the painkillers and doing as I was told!
The following week (January 12th) I returned to work on a half day basis. I now think this was too soon because it was not easy to do my exercises and get ice at work.

Andrew Caldwell comments:
The decision to return to work is individually specific and influenced by a patients’ occupation but encouraging the earliest and safest return to work with modified hours is advised. Patients  recover better when in their normal social environment but need to arrange that they can continue rehabilitation to achieve optimal results.

By January 19th and the fourth session I was up to 100 degrees but I still had some pain on the medial (inside) of the knee. This was very localised. After the fifth session on January 26th I was up to 115 degrees and started some strengthening exercises also. Mobility was getting better and the medial pain in the knee was starting to subside. I then waited two weeks before my final physio session on February 13th. My knee bend was 125 degrees, but I still could not quite fully extend the joint. Since then I have continued to work hard on the exercises etc and I can now lock out the knee fully. I had 5 hydro therapy sessions (exercises in water) and 6 physio sessions as part of the post operative treatment and care. This was excellent.
I then decided to contact Andrew Caldwell who is a consultant physiotherapist and specialises in sports injury and rehabilitation. Andrew is a colleague and friend who is connected with me through sport and work. He assessed me on February 16th 2015 and advanced my exercise programme to specifically develop strength and flexibility toward sports specific and end stage rehabilitation.

 

Andrew Caldwell comments:
Some post-operative discomfort is normal whilst the body is recovering from surgery and typically isn’t an indicator of danger or damage to the replacement. During exercise experiencing pain up to 5/10 on a pain score (where 10 is severe pain) during exercise then this is OK. This pain should not persist for more than 30 minutes after exercise. Post exercise icing can ease discomfort.

5 months since surgery
Its now 5 months after the knee replacement and I have been doing Andrew’s exercises (there are 10 of them) everyday religiously since that date in feb. I am still going to the pool at least 3 times a week and doing my exercises in the water.
I would not say my knee is 100% yet but I can do things now (e.g half squats) that I could not do before. The strength is returning quickly to my new knee. It still swells up a little especial