The Arthritis NewsletterFall 2014
Total Knee Replacement - Was it all worth it?By Marilyn Mulldoon
In which the author offers an honest appraisal of her less than stellar result of a total knee replacement.
There is no blame to be laid here. The surgeon was brilliant, the physiotherapy more than generous, the pre-hab followed to the letter. So why can I not bend this knee more than 90 – 95 degrees?
Part of the problem is I simply generate too much scar tissue. Six months after surgery my knee was completely encapsulated with scar tissue, rendering it a “peg leg” in spite of routine physio, home exercises, etc.
I am knock-kneed and understand that we are the hardest to re-section. This knee has suffered numerous injuries over the years due to twists, falls, dance injuries and equestrian endeavours with a cheeky mount that deliberately would pass too closely to posts, trees, etc. in order to dislodge said rider. I have Sjogren’s Disease with considerable osteoarthritis and my right knee was considered bone-on-bone, “severe” and hotter than Hades. The right foot turned out at roughly a 60 degree angle and my rheumatologist at the time said if it wasn’t replaced soon, it would be too late.
I walked every day, lost weight, went to the gym and ensured that my quads and hamstrings were ready for the big adventure. I arrogantly thought myself way ahead of the seniors I was in pre-surgery class with – they weren’t doing any of the pre-hab thing…I would most assuredly run circles around them post-op….vain creature!
When I returned to the hospital for the standard physiotherapy sessions it became readily apparent that my knee, compared to those of seniors with no pre-hab, was healing at glacial speed. The others were getting much higher bending scores than I. Site still quite hot and attempts to bend further were agonizing. Told to get a private physiotherapist who suggested there may well be an infection inside or possibly septic arthritis. No infection but site still inflamed and only moderately responding to NSAIDS.
After the scar tissue surgery at six months my sleeping and waking hours were spent in a continuous passive motion machine for three weeks, increasing the bend regularly. I once managed to get up to 107 degrees at physio but it was agonizing and fleeting. Massage therapy was then implemented in concert with physio and back at the gym but I was still battling scar tissue and heat.
Having spent a lot of money and not seeing improvement, I stopped all therapy in early October. The site was still inflamed. I have since seen two leading specialists who say this is the best it’s going to get. Sixteen months postop, the heat finally stops but still struggling to keep knee at a 95 degree bend in spite of regular exercise. Now, as a last ditch effort, I am trying something called fascia manipulation. I have only had a handful of sessions but there has been some relief with loosening scar tissue and trying to alleviate nasty muscle spasms. Life goes on and I am keeping my fingers crossed that one day I will be able to ride a bicycle again, let’s just forget about hostile horses.
Was it all worth it? Given the knee is not in chronic arthritis pain anymore, the foot better positioned and I am able to walk for protracted periods, I would have to say both “yes” and “thank you” to a medical system that gave me a chance. I am grateful. That said, a “functional knee” bends 110 degrees and I will doggedly press on. I am curious though. Is this just unique to me or are there other automimmune patients with less than perfect outcomes?
At any rate, I now sadly acknowledge my careers in both the Bolshoi and Riverdance are now at an end…lol!