Post-Surgery Rehabilitation Challenges for Giant Cell Tumor Patients

Postoperative rehabilitation issues for "giant cell tumor."

Hello, doctor.
I discovered a benign "giant cell tumor" on the outer side of my right knee in mid-June.
I underwent surgery at the end of June, where an artificial bone and a steel plate were implanted for stabilization.
I continued to wear a 0-degree brace, and by mid-July, I had my stitches removed and was recovering well without any inflammation or swelling.
At the end of July, during a follow-up visit, an X-ray was taken, and the doctor said I could start rehabilitation, beginning with 30 degrees and increasing by 15 degrees each week.
I successfully achieved 30 degrees in the first week.
In the second week, I progressed to 45 degrees but experienced intense adhesive pain.
However, I was able to reach the bending goal.
Currently, in the sixth week, I am at 45 degrees in my rehabilitation progress.
I can bear weight on the affected limb with partial assistance.
I feel that after reaching 60 degrees, there will be some adhesive pain.
Should I continue with simple bending and massage for rehabilitation, or should I go to the rehabilitation department for assistance? Or should I wait until two months have passed to consult the doctor about my progress (90 degrees)? Thank you, doctor.

zito, 40~49 year old female. Ask Date: 2020/08/07

Dr. Zhan Xian reply Orthopedics

Hello, may I inquire about the surgeon or the rehabilitation specialist?

Reply Date: 2020/08/07

More Info

Post-surgery rehabilitation for patients with giant cell tumors (GCT) can be a challenging yet crucial aspect of recovery. Giant cell tumors are typically benign but can cause significant local destruction of bone and may lead to complications such as pain, limited mobility, and potential recurrence. In your case, having undergone surgery to remove a GCT from the knee area, it is essential to approach rehabilitation thoughtfully to ensure optimal recovery and function.

Understanding Rehabilitation Goals
The primary goals of rehabilitation after surgery for a giant cell tumor include:
1. Restoration of Range of Motion (ROM): Gradually increasing the knee's range of motion is vital. Starting from 30 degrees and aiming for 90 degrees or more is a common protocol. However, it is essential to listen to your body and not push through severe pain, as this can lead to complications such as adhesions or further injury.

2. Strengthening: Once you achieve a reasonable range of motion, strengthening exercises will help support the knee joint and improve overall function. This is particularly important after the implantation of artificial bone and hardware, as these structures need adequate muscle support.

3. Pain Management: Managing pain effectively is crucial. If you experience significant pain during rehabilitation, it may indicate that you are pushing too hard or that there are underlying issues that need to be addressed.

4. Functional Mobility: The ultimate goal is to return to normal activities, which includes walking, climbing stairs, and participating in sports or recreational activities.

Addressing Your Concerns
1. Pain and Adhesions: The strong adhesive pain you are experiencing at 60 degrees is not uncommon. This can be due to scar tissue formation, which may restrict movement. Gentle stretching and massage can help alleviate some of this discomfort. However, if the pain is severe, it may be beneficial to consult with your physician or a physical therapist to adjust your rehabilitation plan.

2. Physical Therapy: Engaging with a physical therapist can provide you with a structured rehabilitation program tailored to your specific needs. They can guide you through exercises, monitor your progress, and adjust your regimen based on your pain levels and mobility improvements.

3. Progression of Exercises: It is essential to follow a gradual progression in your rehabilitation. If you are struggling to reach the 90-degree goal, it may be wise to focus on achieving smaller increments before pushing for the full range. This approach can help prevent setbacks and ensure that you are not overexerting yourself.

4. Timing of Rehabilitation: While some patients may benefit from starting rehabilitation immediately after surgery, others may need to wait until they have healed sufficiently. Since you are already six weeks post-surgery and have shown good progress, continuing with rehabilitation exercises is advisable, but always under the guidance of your healthcare provider.

5. Consultation with Your Surgeon: Regular follow-ups with your surgeon are crucial. They can assess your healing progress and determine if any adjustments to your rehabilitation plan are necessary. If you feel that your progress is stalling, discussing this with your surgeon can provide clarity on whether to continue with your current plan or explore additional interventions.

Conclusion
Rehabilitation after surgery for a giant cell tumor is a multifaceted process that requires patience and diligence. It is essential to balance pushing for progress with listening to your body’s signals. Engaging with a physical therapist and maintaining open communication with your healthcare team will be vital in navigating your recovery journey. Remember, the goal is not just to regain range of motion but to ensure that your knee functions well in the long term, allowing you to return to your daily activities and enjoy a good quality of life.

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