Total Knees-Unplanned Return to Surgery for Manipulation

A few weeks into my outpatient physical therapy, I noticed, as did my therapist, that my knees seemed to be getting tighter and losing range of motion. I had difficulty straightening and bending my knees. When I went for my post op surgical appt., my surgeon told me he thought I was developing scar tissue and recommended taking me back to surgery, for a same day procedure, to manipulate my knees while I was under anesthesia. I asked if there was something I did, or was not doing to cause this problem and was told ‘No”. I knew I had been pushing myself in therapy (“no pain, no gain”) as I was so motivated to be walking welll again. At times, the therapist told me we should not push me too much as gradual progression to goals is better than inflaming my knees. My surgeon explained that about 6 percent of total knee patients experience this problem of scar tissue but that it usually occurs only in Asians and those folks who form keloid scars on incisions–of which I was neither. The procedure is to bend and straighten your knees to break up any scar tissue then Xray you afterwards, to be sure no fractures occurred (a risk of this procedure) and get you back doing physical therapy as aggressively as possible. You are also given steroids and pain medications orally to be sure you can continue bending and straightening your knees to progress in therapy. Ideally, I was told they want your flexion to be at 100 or better degrees and your extension to be 0, or at least less than 5 degrees when finished with therapy. Not everyone gets to these numbers and some folks do get past 100 degrees for flexion but extension seemed to be my biggest problem affecting my walking. I was about 18 to 20 degrees extension and 75 to 85 degrees flexion pre surgery on October 28–about 6 weeks after my original total knee surgery. I was glad I could go home the same day but did need someone to drive me as they placed me in 2 knee splints since they gave me nerve blocks again to my knees so I couldn’t “feel” much or bend my knees until it wore off later that evening. When I did go back to physical therapy the second day, it was amazing how my flexion and extension had improved, and, with the help of the steroids was able to keep my knee motion progressing to optimal goals in those next weeks.

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