Recovery from knee revision surgery
August 19, 2024 6:59 PM Subscribe
A friend, now 75 years old, had a knee replacement 15 years ago, a revision of that 10 years ago, and is now recovering from the 2nd revision of that same knee. It is now 21 days since the 2nd revision (she is in rehab), and her range of motion is around 75 to 80°. She is very concerned that she is behind schedule with respect to the ROM and is finding PT extremely painful.
Google says that at this many days out she should be at 100°, but that is for the original surgery and not for revisions. For revisions there does not seem to be much information about the expected rate of recovery except that it is more variable than for an original surgery.
Any thoughts or experiences? How concerned should she be?
We assume you are not a doc!
Google says that at this many days out she should be at 100°, but that is for the original surgery and not for revisions. For revisions there does not seem to be much information about the expected rate of recovery except that it is more variable than for an original surgery.
Any thoughts or experiences? How concerned should she be?
We assume you are not a doc!
I don't know anything about this personally, but I dug up for example this interesting study of how fast knee patients gain their ROM back, and the factors that can affect it. Look particularly at the graphs on pages 22-23 that summarize the main results.
FYI age is a factor and also the pre-surgery ROM. If pre-surgery ROM was smaller, then you tend to start at a lower baseline. Interestingly they make it sound as though older patients actually have BETTER ROM on average than younger ones - though that may be because the worse cases are typically operated on at a younger age, or some other confounding factor of that sort.
Those charts only show the average and clearly this is a big old bell curve reaching out from that average line, both above and below it.
Still, my concern would be similar to what she seems to be saying: That she appears to be so far below the averages and "normal ranges" for where most patients are at this point, that it seems like she may end up with a ROM that is well below normal and well below what is needed to do a bunch of the activities of daily life.
So that is very definitely something I would be asking about and raising with both the physical therapist and with the doctor & staff. Because it is better to ask and push for help now while there is still time and room for improvement, than to get to the end of the process and find out, "well, we could have done something 3 months ago but now it's too late."
I don't know if there is anything they can do more than they are, or if it will indeed be too late in 3 months or 6 months, but those would certainly be the questions I would be asking and pushing hard for answers to.
posted by flug at 12:36 AM on August 20 [1 favorite]
FYI age is a factor and also the pre-surgery ROM. If pre-surgery ROM was smaller, then you tend to start at a lower baseline. Interestingly they make it sound as though older patients actually have BETTER ROM on average than younger ones - though that may be because the worse cases are typically operated on at a younger age, or some other confounding factor of that sort.
Those charts only show the average and clearly this is a big old bell curve reaching out from that average line, both above and below it.
Still, my concern would be similar to what she seems to be saying: That she appears to be so far below the averages and "normal ranges" for where most patients are at this point, that it seems like she may end up with a ROM that is well below normal and well below what is needed to do a bunch of the activities of daily life.
So that is very definitely something I would be asking about and raising with both the physical therapist and with the doctor & staff. Because it is better to ask and push for help now while there is still time and room for improvement, than to get to the end of the process and find out, "well, we could have done something 3 months ago but now it's too late."
I don't know if there is anything they can do more than they are, or if it will indeed be too late in 3 months or 6 months, but those would certainly be the questions I would be asking and pushing hard for answers to.
posted by flug at 12:36 AM on August 20 [1 favorite]
Is her physiotherapist telling her she is 'behind' in her ROM target? Or is this what she experienced the last revision? Please encourage her to ask her physiotherapist directly - what is the expected ROM by time t, and am I 'behind'?
She can also call her surgeon with the same question and mention the pain, as that is something that can be managed with the surgeon's help. Finally, we (I work in orthopaedic surgery research) typically expect things (pain, function, rom etc) to settle down by around 6 months post-operatively. 21 days is really fresh.
posted by lulu68 at 1:35 AM on August 20 [1 favorite]
She can also call her surgeon with the same question and mention the pain, as that is something that can be managed with the surgeon's help. Finally, we (I work in orthopaedic surgery research) typically expect things (pain, function, rom etc) to settle down by around 6 months post-operatively. 21 days is really fresh.
posted by lulu68 at 1:35 AM on August 20 [1 favorite]
Just to note: The paper linked by Flug is looking only at primary total knee replacement - they excluded revisions - so it's not the same cohort as OP's doubly-revised friend.
posted by lulu68 at 2:03 AM on August 20
posted by lulu68 at 2:03 AM on August 20
Tell your friend she absolutely needs to have them get on to the pain management and to really focus on, or even double her PT exercises, if possible. She should have a good ice machine to control the swelling and that helps with pain if you use it faithfully.
Massage to break up scar tissue also helps the ache. This website has info under the section on manual therapy. I used vitamin E oil, but my doctor said any oil or soothing lotion would work, just don't rub directly on the scar; massage around it. She should ask when they will allow her to do that.
At 21 days I would think she might be stiff and a bit tender at the start of a PT session, able to work through it, and might will be achy and sore after, but there shouldn't be so much pain that she can't do her full workouts, and she should be able to be comfortable with ice and OTC painkillers between sessions. I don't think her ROM is horrible, but now is the time she should be really pushing to extend, and if pain is what's stopping her, something has to be done.
Because of a major screw-up when I had my right knee replacement, I didn't have any PT for the first week. That first week of PT is so crucial. When I finally went in the second week, the therapist told me I'd never regain full ROM because of not starting PT right away. My response was 'Bet Me." Thanks to grit, a wicked therapist, and exemplary pain management, I managed complete ROM.
I was told that month two was normally when 90 range was expected, and that began happening when I seriously started climbing stairs and doing mid-range squats. Full ROM finally happened in the third month. My surgery was over 15 years ago.
A friend (F67) just had her first replacement with a new and improved procedure and was pronounced full ROM at 54 days out. She was finally allowed on a horse at 75 days out.
Good luck to your friend. Tell her to continue to persevere with it.
posted by BlueHorse at 1:51 PM on August 20 [1 favorite]
Massage to break up scar tissue also helps the ache. This website has info under the section on manual therapy. I used vitamin E oil, but my doctor said any oil or soothing lotion would work, just don't rub directly on the scar; massage around it. She should ask when they will allow her to do that.
At 21 days I would think she might be stiff and a bit tender at the start of a PT session, able to work through it, and might will be achy and sore after, but there shouldn't be so much pain that she can't do her full workouts, and she should be able to be comfortable with ice and OTC painkillers between sessions. I don't think her ROM is horrible, but now is the time she should be really pushing to extend, and if pain is what's stopping her, something has to be done.
Because of a major screw-up when I had my right knee replacement, I didn't have any PT for the first week. That first week of PT is so crucial. When I finally went in the second week, the therapist told me I'd never regain full ROM because of not starting PT right away. My response was 'Bet Me." Thanks to grit, a wicked therapist, and exemplary pain management, I managed complete ROM.
I was told that month two was normally when 90 range was expected, and that began happening when I seriously started climbing stairs and doing mid-range squats. Full ROM finally happened in the third month. My surgery was over 15 years ago.
A friend (F67) just had her first replacement with a new and improved procedure and was pronounced full ROM at 54 days out. She was finally allowed on a horse at 75 days out.
Good luck to your friend. Tell her to continue to persevere with it.
posted by BlueHorse at 1:51 PM on August 20 [1 favorite]
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posted by Iris Gambol at 9:58 PM on August 19 [1 favorite]