Total Knee Replacements

On my rural placement I saw two pts post TKR, the first was an elderly lady in her 70’s and I saw her for her r/v 2/52’s post-op, she was doing well with her rehab, getting over 90° active flexion and only had a few degrees of quads lag but this had improved greatly from her pre-op status. She was compliant with all her exercises and keen to do more. The second TKR was a man in his 50’s, he requested to be sent up to the hospital I was at, as it was closer to his home, after a week post-op in the hospital where he had his operation, in a nearby bigger country town. When we went to see him he only had 40° passive flexion and no activation of his quads, he was in a lot of pain when he tried to move his operated leg and he had quite a bit of swelling around the knee and his quadriceps was extremely tight. He told us the physio management and treatment he got in the hospital where he had his operation was not good at all, he said he hardly saw the physios and the CPM machine was left in his room for him to put on and use himself if he wanted. We couldn’t be sure that he was giving an entirely accurate description of his treatment but from the state of his leg it didn’t look as if he had had very much intervention. We had to do some intensive treatment on this man to try get some movement happening in the knee and get the quads muscle firing. We put him on the CPM machine for a few hours during the day and got him doing passive and active quads exercises. Before the quads exercises we tried to release some of the tension in the quads muscle but he could only handle gentle massage as anything deep caused him intense pain. After a bit of massage his quads started firing a bit. By the end of the week and my placement he was doing a lot better but still not good enough to go home.
From these two cases it really showed the importance of good management post-op. If you took a 70 year old woman and a 50 year old man you would expect the younger of the two to recover better, and even though the woman was a week further in her rehab when I saw her, the man was not even close to the same level after a few days of seeing him which would have been at his 2 weeks post-op mark. A number of factors go into the recovery of a pt post-op but in these cases I think one of the major reasons for the poor recovery of the second case was due to poor post-op management. It also shows that the first few days post-op are extremely important and good management and treatment from the start can cut down the number of days it takes to recover but conversely poor management and treatment from the start can extend the recovery period greatly.