That you had the undersurface of your patella surgically smoothed (with additional titanium and glue) is a
significant piece of information.
Likely, the undersurface of your patella was pocketed with small craters, micro fragments of bone and cartilage, and surface irregularity due to osteoarthritis wear and tear effects.
Surgical smoothing of the patella is invasive, in and of itself. Imagine a rotary powered dry-bit smoothing the surface of a car pocketed with dents from a hailstorm or dust storm. You are under general anesthesia for a reason.
A total knee replacement is a harsh procedure more akin to carpentry work - saws, drills, tugging and pulling. It is not a gentle surgery.
Your post-op physical therapy and home program should be firm but gentle. You are going to have more post op inflammation than the typical TKR given the patellar smoothing. Every ROM exercise, although necessary, will incite more inflammation and localized swelling and bursitis (inflammation and swelling of the bursa that serves as a “pillow” to cushion the patella) than a comparative TKR with a retained patella or a plastic patella replacement. Your’s is a less typical scenario (with patellar smoothing) and should be addressed with an individualized therapy program.
A. Low repetitions. Low repetitions. Focus on low repetitions to keep further irritation at a minimum. Have each ROM exercise be of high quality, high value in your effort. Ex. You will be best served with 3 repetitions of flexion with end-range sustained stretch 3 times a day then 15 repetitions done with higher velocity 3 times a day. Slow and steady approach, focus on quality of the movement rather than quantity of repetitions. Quality of movement (slow, smooth, gliding through the entire arc of motion) is the more important.
B. Slow and sustained stretch for end range flexion. Avoid fast, dynamic, ballistic movement/ROM.
Passive positioning for end range extension (place a small washcloth under the ankle while the leg is straight on your bed/may/floor).
C. Ice after every ROM session. Ice for 15-20 minutes. Let ice be your friend.
D. You mention attaining 125 degrees of flexion last week. Caution: Yoi are approaching the biomechanical limit of your replacement joint. A TKR joint should not be stressed to flexion beyond 120-125 degrees in recovery. Do NOT seek a higher ROM. In fact, keep flexion end range to 115 degrees. No further. Your therapist is placing the joint at its biomechanical limit by recommending you push to 125 degrees flexion. You will have time - at a later time - to address further flexion if you need the additional range. Flexion to 120 degrees is an optimal goal. You have achieved the optimal. Back-off, slightly. Less forced end range.
Not all therapists are equal in their skill set and ability to modify a treatment plan based to the individual (you). It is easy for a low caliber therapist to employ a
cookie cutter template therapy program. Do not hesitate to search for a clinic/therapist that has a higher level of clinical competency.
This is your knee. If something feels amiss in the exercise program given to you, trust your instinct.
My opinion, opinion only . . . Your post operative exercise program has been too intense, contributing to reactive patellar bursa inflammation and fluid collection. This in relation to patellar surface smoothing (which in itself will significantly up the inflammatory response). This is a physically demanding surgery, carpentry work. Inflammation will persist (rightfully so) for upwards of 6 -8 months - gradually receding bit present none-the-less.
Be focused but gentle in your knee rehabilitation of the joint and surrounding muscles and ligaments. Quality of exercise regimen is more important than the quantity. Keep repetitions low. Move the joint frequently to avoid stiffness but not aggressively. Ice, ice, ice. Respect the need for rest, keeping the leg elevated for a few times a day.
Orthopedists tend to downplay the recovery period. They do surgery and are then focus on the next upcoming case. A sort of assembly line mentality.
I think you will have a good recovery and fully functional knee in the long term.
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Post Edited ((Seashell)) : 8/6/2018 12:59:01 AM (GMT-6)