Knee Replacements are a treatment for advanced arthritis of the knee, usually resulting from normal wear and tear or trauma. The cartilage surfaces of the knee are replaced. These new joint surfaces are made of metal alloy and plastic, and (of course) have no nerves, effectively ending the painful cycle.
Recovery from a “total knee” can be variable, and is influenced by factors such as the amount of motion, strength and deformity prior to surgery, the amount of swelling after surgery, the aggressiveness (over or under) of the rehabilitative program, and fear. This patient had a few weeks of treatment at home, however, on his follow-up surgical examination, his surgeon became concerned about his lack of motion and gait abnormalities (limping) and referred him for more aggressive outpatient therapy.
His knee motion was severely limited in both flexion and extension – the ability to bend and straighten. His hip strength was one source of his walking difficulties, along with his lack of knee motion and strength. He had a knee flexion contracture – stiffness that prevented him from reaching within 10 degrees of a fully straight leg – and was limited to 90 degrees of knee bending
We focused very aggressively on restoration of motion. As the case can be, we had to pursue multiple strategies and find an approach that worked best for him. Normally that is the approach that not only yields the greatest motion gains, but also the shortest amount of residual pain after each treatment. We did not wait to start agility (fine motor training) because these activities promote normal movement and walking, and also improve strength and pain. After tackling his motion, we worked on his hip girdle strength, walking mechanics, and then on his balance and muscular strength about the knee and ankle.
His ability to walk and balance were restored, and he returned gradually to his normal, active lifestyle, after 12 visits. He did continue to have some residual pain after long trips in the car. He was able to reach While I would have preferred 2-4 more visits to complete his progress and achieve his treatment goals (walking upstairs foot-over-foot without a rail, further restoration of his motion) his surgeon opted to end his care and wait for his other knee to be replaced before continuing with therapy. He was 5 degrees from being completely straight, and able to bend his knee to 120 degrees.