Post-Operative Challenges After Knee Replacement Surgery: A Patient's Journey

Postoperative care for total knee arthroplasty?

My mother is 65 years old and underwent total knee arthroplasty in July 2015, with the artificial joint being covered by health insurance.
She opted to pay out of pocket for high-strength bone cement and a minimally invasive tibial extension rod.
The hospital indicated that the first three months post-surgery are the "golden rehabilitation period," and if the knee joint's range of motion is not achieved within this timeframe, it would become significantly more challenging later on.
Unfortunately, my mother has been performing her rehabilitation exercises incorrectly at home, which not only hindered her progress but also resulted in a back injury.
Subsequent examinations revealed severe osteoporosis, with a DXA T-score of -4.7, necessitating additional treatment for her back.
As a result, she has been attending rehabilitation at the hospital daily for over a year, but she still cannot walk normally.
After about 20 minutes of walking, she experiences tightness and pain behind her knee, and she is unable to squat or ride the stationary bike at the rehabilitation center.
We are uncertain whether this is a sign of contracture or if it indicates surgical failure.
Is there any possibility for improvement in her condition? Despite over a year of rehabilitation, her attending physician has informed her that continuing the current rehabilitation will yield the same results.
Currently, after the surgery on her left leg, she primarily relies on her right leg, which is still undergoing hyaluronic acid injections.
However, the doctor has warned that improper use of the right leg could lead to the need for surgery in the future.
My mother is now fearful of undergoing another surgery on her right leg due to the current state of recovery in her left leg.
I would greatly appreciate any insights or advice regarding her situation.
Thank you.

Leilei, 40~49 year old female. Ask Date: 2016/10/19

Dr. Shi Guozheng reply Orthopedics

After total knee arthroplasty, poor joint mobility may lead to some functional decline, but it should not result in an inability to walk.
If the knee flexion is less than 90 degrees for more than three months, it becomes more challenging to achieve further bending.
If there is persistent pain in the joint more than a year after surgery, it is necessary to return to the hospital for evaluation to check for other issues.
If there is degenerative joint disease in the right knee, early treatment is essential.
In addition to medication, rehabilitation can be conducted simultaneously.

Reply Date: 2016/10/19

More Info

Post-operative challenges after knee replacement surgery can be quite complex, especially for older patients like your mother. At 65 years old, undergoing knee replacement surgery is a significant step, and the recovery process can be fraught with difficulties, particularly if rehabilitation is not approached correctly.

Firstly, it’s important to understand that the initial three months post-surgery are indeed considered a critical period for rehabilitation. During this time, the focus should be on regaining range of motion and strength in the knee joint. If the knee is not adequately mobilized during this period, it can lead to complications such as stiffness or even arthrofibrosis, which is the formation of excess scar tissue that can severely limit movement.

In your mother’s case, it seems that her rehabilitation efforts at home were not effective, which may have contributed to her current difficulties. The fact that she has developed severe osteoporosis, as indicated by a T-score of -4.7, complicates her situation further. Osteoporosis can lead to fractures and other complications, particularly in the lumbar spine, which may explain her back pain. It’s crucial to address her bone health through appropriate medical management, including possible medications to strengthen her bones.

Regarding her knee, the persistent pain and inability to perform basic movements like squatting or cycling could indicate several issues. It might be related to muscle weakness, joint stiffness, or even the possibility of a surgical complication. The tightness and pain after walking for 20 minutes could suggest that she is experiencing muscle fatigue or joint strain, which is not uncommon in individuals who have undergone knee replacement surgery, especially if they are compensating with their other leg due to pain or weakness.

To improve her situation, a multi-faceted approach is necessary:
1. Physical Therapy: Continuing with physical therapy is essential. It may be beneficial to work with a therapist who specializes in post-operative rehabilitation for knee replacements. They can provide tailored exercises that focus on improving strength, flexibility, and range of motion without overstraining the joint.

2. Pain Management: Addressing her pain is crucial for her to engage in rehabilitation effectively. This could involve medications, physical modalities like heat or ice, and possibly injections if deemed appropriate by her physician.

3. Education on Proper Techniques: It’s vital that she learns the correct techniques for exercises and daily activities to avoid further injury. This includes understanding how to properly use assistive devices if needed.

4. Bone Health Management: Given her osteoporosis, it’s important to consult with her healthcare provider about medications or supplements that can help improve her bone density. Weight-bearing exercises, as tolerated, can also be beneficial for bone health.

5. Psychological Support: The fear of needing another surgery can be daunting. Psychological support or counseling may help her cope with her fears and anxieties regarding her condition and treatment.

6. Regular Follow-ups: Continuous monitoring by her orthopedic surgeon is important to assess her knee's condition and make necessary adjustments to her treatment plan.

In conclusion, while your mother’s situation is challenging, there are avenues for improvement. It may take time and a concerted effort from both her and her healthcare team, but with the right approach, it is possible to enhance her quality of life and functional abilities. It’s essential to remain hopeful and proactive in seeking the best care for her recovery journey.

Similar Q&A

Post-Operative Concerns After Minimally Invasive Knee Replacement Surgery

My father underwent a total knee replacement at the end of March this year. He has been consistently participating in rehabilitation since the surgery, and it has been almost four months post-operation. However, he still experiences some swelling and pain, and he is unable to nav...

Dr. Chen Yongxue reply Orthopedics
Hello, the swelling and pain after joint replacement surgery can vary from person to person. It is quite common within the first three months post-surgery. Using a knee brace for compression and elevating the affected limb can help improve the condition. Additionally, diligent re...

Post-Operative Rehabilitation and Care for Knee Replacement Surgery

Hello Dr. Cheng, my mother is scheduled to undergo knee replacement surgery this week. I am unclear about the rehabilitation process after the surgery. Is there a need to control her diet? I would appreciate your guidance on these issues. Thank you!

Dr. Zheng Shunping reply Rehabilitation
In response to your question: After total knee arthroplasty, there will be swelling and pain postoperatively, which must be managed with medication. Simultaneously, passive range of motion exercises for the knee joint should be gradually initiated, and a Continuous Passive Motion...

Evaluating Recovery After Knee Replacement Surgery: Fitness Assessment Tools

How can we assess the healing status after knee replacement surgery? If we use physical fitness as a measure, is there a specific assessment scale to evaluate the condition after knee replacement surgery? Thank you!

Dr. Lin Yijun reply Orthopedics
The recovery after knee joint replacement surgery involves a wide range of factors. In addition to the range of motion of the knee joint and the strength of the surrounding muscles, it also includes the range of motion of other joints and the muscles around the hip and calf. This...

Understanding Post-Operative Knee Pain After Joint Replacement Surgery

Hello Dr. Shih, over ten years ago you performed a knee replacement surgery on my mother (right knee), and she has been doing well since then, thank you! Last May, my mother (75 years old) underwent a left knee replacement. Recently, she has been experiencing significant pain in ...

Dr. Shi Guozheng reply Orthopedics
There are many possible reasons for persistent pain one year after knee replacement surgery. The most common cause is overuse leading to inflammation; resting or taking medication may help improve this condition. Less common causes include wear and loosening of the implant, and t...