Managing Pain After Knee Fracture Surgery in Seniors: Tips and Insights

Fracture near the knee?

Hello, my mother had a car accident in 2020 (at the age of 80) that resulted in fractures of the distal femur in her left leg and the proximal tibia near the knee in her right leg.
She underwent surgery, which was successful, but she has been experiencing sharp pain at the surgical site while walking, which has led to difficulty walking for extended periods and a fear of walking.
It has been three years since the accident, and I would like to know if this is a normal condition.
If it is not advisable to remove the internal fixation due to her age, what methods can be used to improve her situation? Thank you!

VIVIAN, 40~49 year old female. Ask Date: 2023/06/06

Dr. Shi Guozheng reply Orthopedics

If walking causes pain, an X-ray should be taken to check for any issues related to arthritis.
If there is no pain, it may not be necessary to remove internal fixation devices.
An X-ray can help determine the cause of the symptoms, allowing for targeted treatment.

Reply Date: 2023/06/06

More Info

Managing pain after knee fracture surgery, especially in seniors, is a multifaceted challenge that requires a comprehensive approach. Given your mother's situation, where she experienced a distal femur fracture and a proximal tibia fracture, it is not uncommon for patients to experience lingering pain and discomfort even years after surgery. Here are some insights and tips to help manage her pain and improve her mobility.

Understanding Post-Surgical Pain
1. Nature of Pain: After knee surgery, especially in older adults, pain can stem from various sources, including:
- Nerve Damage: Surgery can sometimes lead to nerve irritation or damage, resulting in sharp, shooting pains.

- Scar Tissue Formation: The formation of scar tissue around the surgical site can lead to stiffness and discomfort, often referred to as arthrofibrosis.

- Joint Changes: Age-related changes in the joint, such as arthritis, can exacerbate pain and limit mobility.

2. Normalcy of Symptoms: It is not unusual for patients to experience pain long after surgery. However, if the pain is persistent and significantly impacts daily activities, it may warrant further evaluation by a healthcare professional.

Pain Management Strategies
1. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can tailor exercises to improve strength, flexibility, and range of motion, which may help alleviate pain over time. Gentle stretching and strengthening exercises for the quadriceps and hamstrings can be particularly effective.

2. Pain Medications: Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can help manage pain. However, it is essential to consult with a healthcare provider before starting any medication, especially considering her age and potential interactions with other medications.

3. Heat and Cold Therapy: Applying heat can help relax muscles and improve blood flow, while cold therapy can reduce inflammation and numb sharp pain. Alternating between heat and cold may provide relief.

4. Assistive Devices: Using a cane or walker can help reduce the load on the affected leg and provide stability while walking. This can alleviate fear and encourage more mobility.

5. Weight Management: Maintaining a healthy weight can reduce stress on the knee joint. If weight loss is necessary, a balanced diet and regular low-impact exercise, such as swimming or cycling, can be beneficial.

6. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture, massage therapy, or yoga. These methods can help manage pain and improve overall well-being.

7. Regular Follow-ups: Regular check-ups with her orthopedic surgeon or primary care physician are crucial. They can assess the healing process, evaluate the need for further interventions, and discuss the possibility of removing internal fixation devices if deemed appropriate.

When to Consider Surgery
If her pain persists and significantly limits her quality of life, it may be worth discussing the option of removing internal fixation devices with her doctor. While age can be a factor in surgical decisions, if the hardware is contributing to pain or discomfort, removal may provide relief.

Conclusion
In summary, managing pain after knee fracture surgery in seniors involves a combination of physical therapy, medication, lifestyle adjustments, and regular medical follow-ups. It is essential to approach this issue holistically, considering both physical and emotional aspects of recovery. Encouraging your mother to stay active within her limits and providing emotional support can also significantly impact her recovery journey. Always consult with her healthcare provider before making any changes to her treatment plan.

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