Total Knee Replacement due to Osteoarthritis
A 54-year-old recently retired fire fighter attended for treatment, assessment and advice regarding his long standing knee pain.
In the past he had undergone multiple knee joint injections and arthroscopic (Key hole) surgery to repair torn menisci (cartilage) in both knees.
He had seen many physiotherapists over the years and essentially felt that until recently he was managing his symptoms independently. He has no other medical issues other than mild hypertension and he runs a Karate club, training up to 4 times per week.
Over the preceding year his functional ability had declined having an impact on his daily life and sport. He wanted to enjoy his recent retirement with his wife and grandchildren.
His most recent visit to an Orthopaedic surgeon had concluded that he was finally ‘old enough’ to undergo a Total Knee Replacement.
- A constant nagging pain deep in the left knee.
- Was taking maximum dose Ibuprofen and paracetamol.
- Occasional giving way and a feeling of ‘instability’…”I don’t trust it”.
- Regular swelling around the knee after activity.
- Disturbed sleep.
- Unable to walk further than 100 yards without pain/limp.
- He was now unable to demonstrate/carryout any Karate moves and kneeling was painful.
- Morning stiffness and difficulty descending stairs.
- He absolutely did not want to use a walking stick
- Altered gait (walking) pattern with a reduction in weight-bearing over the left knee
- Standing on a slightly flexed left knee
- Swelling and joint line thickening – ‘Arthritic Looking Joint’
- Wasting of the quadriceps muscle
- Poor balance and Proprioception
- Range of motion restricted to no more than 100 degrees of flexion without pain
- Crepitus (noisy) knee joint and patella-femoral joint (knee cap) with flexion
- Reduced muscle strength in the left leg
- Poor core stability
- Pain on palpation along the knee joint line
- Positive special test for meniscal damage
Moderate to Severe Osteoarthritis in the left knee with likely underlying meniscal damage/degenerative change.
For more specifics regarding an arthritic joint – see Paskys “wear and tear” case study.
Pre-habilitation x 3 sessions over a period of 6 weeks
- Re-iteration of appropriate footwear, basic diet, joint supplement advice
- Ice therapy regularly, not just after exercises.
- Gentle Cycling using a static cycle.
- Hydrotherapy (pool based) exercises
- Manual therapy including soft tissue massage, trigger point release around the quadriceps and back of knee.
- Basic balance and proprioception exercises
* Nb. All within the patient’s pain tolerance levels
We also discussed what was likely to happen when in hospital, checked he was ok with his basic quads exercises as the hospital physio would be around quite soon after surgery to start mobilisation! We practiced the use of elbow crutches both on the flat and also up and down stairs.
Post –operative – 2 weeks after surgery. Weekly apts for the first 3 weeks
- Checked post op exercises and progressed as pain allowed
- Scar tissue management; soft tissue massage and taught patient to manage this independently
- Gait (walking) re education, progressing from using 2 walking sticks to one then none within 4 week post op.
- Lower limb strengthening exercises, core stability exercises and stretches
By 2 months post–op he was swimming regularly and needed no further physiotherapy input.
By 3 months post-op he was walking up to 3 miles
By 6 months post-op he was cycling past 6 miles
By 12 months post-op he had forgotten about his ‘new’ knee !!