I am currently working with 5 people who have had knee replacements over the last 5 years. This is nothing new I am a expert at treating and helping with mobility of knee replacements. But the key trend I am seeing is people who have had the surgery 1 to 3 years ago and not still have poor mobility and in some cases significant pain. Two cases have had both knees done over the last 5 years and are still struggling.
Why is this the case?
3 years ago was Covid and all the obvious challenges that brought and issues for 2 years while the NHS and Private health stabilised to some sort of normal. But the last 18 months have been balanced and 5 years ago it was business as usual so why the trend and increase?
I feel its down to numbers in various forms, 2015 there were 160,000 hip and knee replacements annually in the UK. This number would have crashed over Covid but generated a waiting list that needs to be worked through. The Knee replacement operation from a surgical perspective is a great success with a 99% success rate and significant improvements in adaptions should something go wrong. The surgery is relatively fast and time in hospital is usually 3 to 5 days with some patients leaving on the second day. Medication, recovery and pain relief is effective 6 to 12 weeks and the osteoarthritis is gone and the knee replacement is accepted by the body.
The issue is in the knee replacement rehabilitation!
Depending on your age and mobility pre operation and post surgery the amount of physio support you have varies significantly. The goals are consistent 90 degree bend in the knee, walking up and down stairs, walking a usual distance, sit to stand and transfers. Initially this is done with crutches post surgery for discharge and follow ups are done over the next 6 weeks where you gradually move from crutches/frame to crutches/sticks to independence or crutches to independence depending on your mobility. This can take up to 12 weeks in some cases but the focus is on discharge as quickly as possible. The problem comes after this time. People have adapted to their new movement and mobility and are fine over short distances and doing normal modified tasks, the issues start when they try to be normal.
What I mean is doing normal things, longer car travel, driving, walking around shops for longer periods of time, standing and socialising. All these activities they have not rehabilitated for as I term it their bubble of recovery was small and they have not pushed the boundaries. So what does the surgery do? it cuts away damaged bone and replaces it with a metal insert top and bottom so the joint is metal on metal. Due to how the surgery is performed the knee joint is stretched to fit the inserts in. This stretches the four major ligaments and 4 major tendons, which is why the knee feels tight and difficult to straighten or bend. Also due to the surgery your knee, hip and ankle are all in line and straight which means you have to walk differently, you are not normally shown how to. Bending is a issue as you need to bend the knee to 120 degrees to do lots of things and more if you want to knee or lunge. Medically once your knee replacement has healed you could kneel on it very few do due in most cases to lack of mobility followed by fear.
I always work to increase peoples life bubble and be able to do more, with focused gait and walking analysis and development. Structured exercise to help with tightness, range of movement, strength and endurance. I have more dedicated time and focus so get better results. I also work hard on changing movement patterns and habits so people can do more pain free.
