Knee Replacement Recovery — The Six Week Phone Call
(or “It’s six week after knee surgery, and you’re staring into the physical therapy abyss!”)
– by PJ Ewing
It starts with the scheduled ’15 Minute Call’—
PJ (in green) and “Miriam” (in blue)
“Hello is this Miriam?”
“Yes, this is she.”
“Hi Miriam this is PJ a knee recovery coach; we have a call scheduled for now to discuss your knee.”
“Oh, hi, I am looking forward to speaking with you.”
“Great, how are you doing today?”
“Well I would be a lot better if I could bend my knee…”
I always regret that last part! I already know how Miriam is doing… just miserable thank you very much. I know this because Miriam’s request for a call came in at 3:00 a.m. because she could not sleep. And the story is so often the same across most of the knee patients with whom I speak day in, day out. The conversation usually goes like this…
Miriam: “My knee replacement was six weeks ago. I am in an outpatient clinic now and I am working really hard. But it is so painful and I am just not making any progress. I still have swelling and I am getting really frustrated. My physical therapist and my surgeon are very concerned at six weeks after knee surgery. I cannot bend more than 80 degrees. My surgeon has said that if I cannot bend more than 100º in two weeks he is going to have to do a Manipulation Under Anesthesia. I really do not want to do that. Can you help me?”
50, 60, 70-somethings have a knee or two replaced for some pretty important reasons.
1) Eliminate pain
2) Get their mobility back so they can do activities that they love to do
3) Get their lives back after years of declining movement, motion, involvement, fun
When the recovery stalls after 3-6 weeks they naturally get upset, if not really and truly depressed, about the whole thing. I cannot tell you how many time I have heard the words “I wish I had never had this surgery. I’d rather go back to my bone-on-bone self if this is all I am going to be able to do after the surgery.” Oftentimes a lack of knee bending is just not their fault… and I know it can be fixed. Here are some of the facts about recovery after knee replacement (all supported by extensive research):
- Orthopedic surgeons want you to regain your range of motion quickly. Their hope is that you achieve 115º ROM within three months.
- Between 4 and 7% of all knee replacement patients require a Manipulation Under Anesthesia (MUA)
- The reasons for MUA vary but include knee condition prior to surgery, knee injury/surgery history, being overweight, smoking, aversion to pain, opioid allergies, ethnicity, younger age and poor motivation. Women also have a tougher time recovering when compared to men.
- 25% of MUA patients require a second MUA as their recovery was not acceptable after the first MUA procedure.
- If you have an MUA you are 2-3 times more likely to need a revision knee replacement surgery earlier than you would otherwise.
- MUA patients do not achieve the same range of motion as non-MUA patients.
Six Weeks After Knee Surgery
As the voice on the other end of this “knee recovery lifeline” phone call it is my job to provide sound, actionable advice. My callers get to bounce ideas off of me knowing they will get an honest, un-varnished answer, not a sales pitch. I am someone with whom they can discuss the options they have then and there to avoid the Manipulation Under Anesthesia (MUA). If it is just too late to do that, we discuss how to recover properly afterwards. As I see it each patient who finds them self in this ‘recovery no-man’s land’ has three choices to avoid the Manipulation Under Anesthesia (handicapped for success as best I can):
Stay the course and continue the current regimen (chance of success 25%)
Tweak the recovery program (chance of success 35%)
More Intense physical therapy
Change therapists or clinics
Try new exercises
Look to a radical change in therapy (chance of success 70%)
New recovery technology and tools
Non-traditional therapy, massage, stretching, icing techniques
My reasoning behind the chances of success is as follows. Most knees are starting to reveal their potential by six weeks after knee surgery. The knee is “getting comfortable” where it is. To move a knee out of its current angle of bend at six weeks or so will take a real push. At this point we know what the effect of physical therapy is, and if bending and straightening are still problematic it is time to change course. Often the patient and their P.T. know if there is a “hard stop” in the knee and it just… will… not… bend any further (MUA is the likely answer here). If “there is room” to move, but it is just too painful to do it, then we have more hope as scar tissue has not completely stopped the knee’s ability to bend.
Standards for Success
You will hear a lot of different expectations from surgeons six weeks after knee surgery, and for good reason. Your surgeon knows your knee better than anyone else. He (or she) knows that your pre-surgery range-of-motion (ROM) can be indicative of your post-surgery range-of-motion. Your surgeon also knows what your stated goals are after your surgery. It might be that you just want to eliminate the pain and sit normally again. In that case the ROM goals can be modest. 90º-100º ROM is fine. For other surgeons it is 120-130º bend, or bust. Riding a bike, hiking a tricky trail, doubles tennis are your stated objectives, and knowing this, your surgeon will insist on performance-level results.
Surgeons’ Approach to Manipulation Under Anesthesia
And each surgeon’s approach to the Manipulation Under Anesthesia can vary widely. Most will tell you that they want over 100º at six weeks post-surgery at a minimum. They will also put on the pressure for you to get to 115º within a few more weeks or they will book the Manipulation Under Anesthesia. Additionally they know that by 12 weeks post-surgery it might be impossible to do the MUA at all without tearing more than just the scar tissue that is impeding your motion. Time is a factor and the 12 week mark is a pretty firm line in the sand for most. I have seen surgeons keep open the door for the Manipulation Under Anesthesia through 16 weeks and even 20 weeks, but those are pretty rare.
The Tools Available to an Orthopedic Surgeon after Surgery
Once your surgeon staples you back together (or glues you depending on his approach) his tools to help you get back to your life are as follows:
In-patient physical therapy (live-in)
Home physical therapy
Outpatient physical therapy (local clinic)
Manipulation Under Anesthesia (MUA) followed by intense P.T.
Second Manipulation Under Anesthesia (MUA) followed by intense P.T.
Arthroscopy (invasive use of arthroscope to cut out scar tissue) followed by intense P.T.
Second Arthroscopy followed by intense P.T.
Revision Surgery (removal of some or all of the prosthesis and the installation of new hardware) followed by one or more of the above
Knowing this and the fact that my “six-week-caller” wants to get out of nearly all of these options and get back to life at all costs I have to bring up the X10 Knee Recovery System™ to those who clearly need to take steps to get their recovery back on track. If a post-surgery knee patients wants the best odds of avoiding the MUA then the X10 provides a radically different therapy intervention that has proven itself thousands of times over. It is not a guarantee for success as the pace of scar tissue development can vary widely. However, the X10’s ability to ‘provide meaningful range of motion gains without the pain that accompanies traditional therapy’ makes it stand apart from all other therapies.
In the end I want my callers to understand two really important things. First it is very likely not their fault that they are struggling with their recovery and, second, there is hope. With or without the X10 if they really want to recover and are willing to put in the effort they can achieve the goals they set out for themselves. There are many tools to help knee patients get better… like massage therapies, and icing strategies; there is a wealth of experience behind me on our team at X10 Therapy.
Recovery, like life, has its ups and downs. Those that find X10 on YouTube or in Google have already proven to me that they are willing to put themselves out there to find a solution to this bending problem. I already know they are willing to work hard… now it is just a matter of applying the right tools at the right time to give them a chance at success… and getting to the life after knee replacement that they deserve after all this hard work.
If you want to speak with me or one of our other amazing knee coaches to talk about your situation just click here or on the “Schedule a Free Phone Consultation” box on the side of this page. I know you will be glad you did no matter what your situation is.
Oh, and if it is me, I’ll do my best to not to ask you ‘how you are doing today’!
The X10 Meta-Blog
We call it a “Meta-Blog” because we step back and give you a broad perspective on all aspects of knee health, surgery and recovery.
In this one-of-a-kind blog we gather together great thinkers, doers, writers related to Knee Surgery, Recovery, Preparation, Care, Success and Failure. Meet physical therapists, coaches, surgeons, patients, and as many smart people as we can gather to create useful articles for you. Whether you have a surgery upcoming, in the rear-view mirror, or just want to take care of your knees to avoid surgery, you should find some value here.
RESEARCH REFERENCES  Physical Impairments and functional limitations: A comparison of individuals 1 year after Total Knee Arthroplasty with control subjects. Walsh M. Woodhouse LF, Thomas SG, Finch E.  How often is functional range of motion obtained by manipulation for stiff total knee arthroplasty? Ho-Rim Choi & John Siliski & Henrik Malchau & Andrew Freiberg & Harry Rubash & Young-Min Kwon  Manipulation Under Anesthesia After Total Knee Arthroplasty is Associated with An Increased Incidence of Subsequent Revision Surgery Brian C. Werner, MD, James B. Carr, MD, John C. Wiggins, BS, F. Winston Gwathmey, MD, James A. Browne, MD  Clinical, Objective, and Functional Outcomes of Manipulation Under Anesthesia to Treat Knee Stiffness Following Total Knee Arthroplasty Kimona Issa, MD, Bhaveen H. Kapadia, MD, Mark Kester, PhD, Harpal S. Khanuja, MD, Ronald E. Delanois, MD, Michael A. Mont, MD  Continuous Passive Motion After Knee Replacement Surgery, Cochrane Collaboration Musculoskeletal Group Harvey LA, Brosseau L, Herbert RD