A Tale of Two Knees

With 4.5 million Americans currently living with knee replacements, it is fast becoming in extremely common procedure. While improved technology and surgery techniques are making this procedure much more successful, patients are still not well informed as to the reality of post surgery recovery. One study of patients undergoing physical therapy post knee replacement showed the majority of patients only completed eight weeks of physical therapy, and at this point their mobility was worse than before the surgery. The recovery is even worse for people who are obese, elderly, have multiple joints replaced or multiple joints affected with pain. Acupuncture is an approach that has been used very successfully post-surgery and many more studies are showing acupuncture helps this process by reducing inflammation and pain post surgery. However, when people only look at scientific articles it is difficult to translate this into what this actually means for your recovery post surgery, specifically what are you actually going to feel and be able to do with your new knee. For this reason here is a story of two patients who came in for knee problems post knee replacement surgery. The first patient came in immediately after surgery, the other six months after.

For patient #1, while their knee was sore and swollen like it typically is post replacement, they were only a week out of their surgery and everything lay before them as they endeavored to do everything they could to recover well. For patient #2, it had certainly been “the worst of times.” Six months out from their knee replacement adhesions had formed all around the knee, walking was a continually painful exercise and the tension and pain was not only worse than it had been before the surgery, but now the hip, the back and the opposite knee were also starting to become very painful. This all despite the fact both patients were undergoing physical therapy for their knee directly after their surgery.

When treating patient #1 immediately after their surgery we did not do acupuncture and massage directly over the replaced knee as the risk of infection is still high in the initial stages. The treatment consisted of acupuncture points above and below the knee, points in other areas of the body, which are beneficial for pain and healing of the knee, and massage on the leg, hip, back.  In general, the treatment was designed to not only help the affected knee, but to also treat other areas of the body to help the muscles and tissues not become tight and sore from the compensation of walking with a limp post surgery. As the treatments went on we were able to treat more directly on the affected knee and electrical stimulation was applied to further decrease pain and increase circulation through the affected area. After only four weeks patient #1 was able to ride a bike, have nearly 110^o of flexion in the knee, and perform many different weight bearing exercises. Not only that, but the opposite knee(which the doctors advised replacing in the future) was having no problems and felt better than it had in years. At six weeks the knee would feel some soreness post a heavy workout, but otherwise felt mostly recovered. At eight weeks the knee felt as good as it had in years. At this point was when I saw patient #2 who was six months post surgery, walking with a cane and having problems throughout their back, hip and other knee. Immediately we began a similar procedure as in patient #1 with the addition of massage to break apart the scar tissue and adhesions that had formed. After 4 weeks the patient was recovering well, they had increased movement, were riding a bike daily and had a decrease in their pain, however the knee still would get sore after a mild workout and it took a few more months before they began to see the improvements that patient #1 saw after only 6 weeks.

These stories are by no means singular cases. While anecdotal case studies are not an depth scientific analysis as to the physiological mechanisms involved in post surgical care, they are perhaps more relevant to you the patient. Through hearing these stories you can know what you should expect post surgery, and more importantly what kind of treatment you should be receiving. Too often I see patients come in many months post surgery in the same state as patient #2 because they were never told what their options were for optimal recovery. Inevitably when I explain to them what there recovery plan should have looked like they are frustrated they didn’t receive the information beforethe surgery. So, if you are looking at getting a joint replacement, or any surgery for that matter, please seek a qualified acupuncturist, massage therapist and physical therapist. It will be the difference in recovering twice as fast with little to no complications.