So, it’s three weeks since I had my follow-up appointment with my surgeon, and saw one of his registrars, rather than the man himself, although I could hear him behind the scenes. I’ve taken some time to assimilate what was said there and at my last physio appointment. In summary he said:
New joint is good, well positioned and surgery went well.
Healing is good, quads are strong, extension is good.
The pain at the back of the knee is ham-string and will improve as my extension gets better (extension was at 0 and has been for some time, so I’m not sure about that).
Flexion is poor, but not uncommon in “younger” patients like me (62!)
I should be using a stationery bike to improve flexion.
My physio should be pushing my leg to increase flexion.
My physio should be pushing down on my knee to increase extension.
I should use my other leg to push back the new knee to increase flexion.
He would see me again in 6weeks, to see how things were going.
I asked him to repeat some of the exercise instructions so I could pass them on to my physio correctly and took notes immediately I left the department. I felt positive that I wasn’t being left with a poor ROM, but was a bit wary of some of the instructions.
Surprisingly, my knee felt a bit freer the following day. After all the pushing and pulling he did I was expecting a lot of swelling!
3 days later I had a physio appointment. Due to the cancelling of electives over Christmas I had the physio to myself, rather than the normal group session, so we were able to go over everything that the registrar had said. The physio was quite sceptical about his understanding of how post-surgery physio operates in the NHS (he trained in Belgium) i.e it is designed to give the patient a set of exercises and the confidence to do them at home. The NHS hasn’t got the capacity, and Physios are not “hands-on”, you can’t expect to achieve big changes in 4 fortnightly sessions.
She actually did some of the manipulations suggested, but advised me that there was no obvious reason why I couldn’t get a reasonable ROM over time doing the exercise programme and keeping at it, given the experience of last time. She certainly didn’t think I needed to be considered for an MUA yet. She suggested I could pay a private physio to push and pull, but would need it at least three times a week for any appreciable change, which would be expensive. I’m guessing that this is the kind of physio so many US patients talk about on here, and that it’s covered by insurance. I did go to a private physio when I was despairing of my right knee 5 years ago, but they were useless, only prescribing exercises I was already familiar with rather than performing any manipulation. I wasted my money.
She told me to keep off the stationery bike as it isn’t a good position for the new knee joint, and there is a tendency to lift your hip to get the pedals round. So I’m sticking to my mini-pedals!
I came away from that physio session calmer and more optimistic about my knee, even though flexion, at 87, is still less than when I left hospital. I took away positives that I’m walking well, my extension is good, there is time to get a better flexion, it’s normal to take months to be able to do stairs in cadence, and that it is not so bad that an MUA is recommended.
Since then I’ve had downs, probably post surgery, stuck in the house blues, but I feel brighter now and am feeling positive.
United Kingdom
