Many patients experience great relief from this surgery, but sometimes the recovery is more difficult than patients initially expect.
He experiences left knee pain and range-of-motion ROM restrictions from past knee surgeries that have been unresolved by previous therapies. His medical history includes a left total-knee replacement TKR in Novemberfollowed by another surgery in December due to a staph infection.
In Februarythe patient had surgery to add a spacer in his left knee, only to undergo a second TKR on that knee in May John began physical therapy treatment shortly after this surgical intervention but it proved ineffective, again limited by pain and soft tissue restrictions.
His left knee was also manipulated in Octoberfollowed by physical therapy that produced little positive impact. He has spent the past three years doing whatever he can to minimize his knee pain while refusing further surgical intervention. John is also skeptical about any physical therapy treatment, having tried three prior regimens without much success.
Presentation and Examination He reports left knee pain anteriorly in the peripatellar region and along his inch scar. His pain ranges from out of 10 on the Visual Analogue Scale VASand he describes it as achy, stabbing, sharp, and shooting.
His physical examination demonstrates: No lateral lumbar shift, and no significant muscle-guarding during ambulation or transfers. The patient appears alert and oriented and is cooperative with exam and history-taking.
No significant tenderness to palpation of lower quadrant and sacroiliac joints. Left is limited degrees with moderate hamstring tightness and 15 degrees of knee flexion to complete the task.
Gait mechanics are altered with knee valgus, hip varus, and bilateral ankle pronation with proximal instability on the left. Trunk rotation is altered bilaterally, with decreased weight-bearing on the left and a positive Trendelenburg sign. Negative neurological exam, normal pulses, with both dorsal pedal and posterior tibial pulses strong and regular.
He is being treated two to three times a week for weeks or until his goals are met. John has currently been seen for 12 visits, demonstrating the following treatment outcomes: Visits During this time period, treatment included modalities to the left knee to improve blood flow and initiate soft tissue mobility.
The Scanner was applied around the quadriceps with the left knee supported at 30 degrees resting positionprogressing to end-range for the patient 87 degrees of knee flexion. Gait training was started to promote bilateral heel strike and stance time.
Knee AROM improved -3 to 94 degrees, with decreased adhesion formation around the scar. Regarding gait mechanics, John demonstrated improved stance time bilaterally, percent improvement in trunk rotation with reciprocal arm swing, straight leg raise on the left degrees, and 9 degrees of knee flexion.Case Studies on the Perioperative Surgical Home and Related Concepts.
These case studies have been submitted by member physicians. Questions concerning the case studies should be . Objective: The study investigated the effect of prehabilitation on the quality of life and function in patients having total knee replacement (TKR)/total hip replacement (THR).
To investigate recovery from total hip replacement community services. A review of international nursing studies of orthopaedic patients by Matt-Hensrud et al A Canadian study compared a group of THR and total knee replacement patients pre and post-operatively, using.
Satisfactory knee function is usually restored after total knee replacement and the majority is able to return to low impact sporting activity (7). Long term studies confirm satisfactory functional scores and show 91% to 96% prosthesis survival at to year follow-up (1,5,6).
Partial Knee Replacement He was debilitated by the pain and was seeking options for treatment. After asking the patient a number of questions, examining the patient, and reviewing his x-rays I decided to do a partial knee replacement.
3 months post-surgery he had no pain, had ° of movement, and was enjoying playing golf again. While there may have been errors/negligent acts on the part of other defendants, the case, comments, and recommendations are limited to the actions of the defendant; the nurse.
The decedent/plaintiff was a 67 year old male who underwent a right total knee replacement.