CAUSE OF PERPETUAL COMPLAINT AFTER KNEE REPLACEMENT -STIFF FEELINGS

     The most heard,rather I would classify it as the ONLY complaint I hear after knee replacement is stiffness,stone like feeling

I thought to find the cause not because it stopped patient progress but because of unnecessary psychological and physical  burden of few other questions which are sometimes  associated with this main issue.

                                         

In order to find the cause I revisited Physiology and Pharmacology for this.

Physiology of muscles and bones post surgery,a reconstruction surgery like Total knee Replacement gives us a deeper understanding of reasons.

I came across lot of points but following I am sharing for the benefit of time and knowledge enhancement.

1.During a knee replacement surgery,surgeon makes a long incision over the middle of knee and cuts the muscle,tendon and ligament .So It implies there is more tissues cut and hence there is more requirement of time to heal them.

2.Up to 20% loss of muscle mass can be compensated by the high adaptability and regenerative potential of skeletal muscle.

3.Muscle regeneration relies on a heterogeneous population of satellite cells, interstitial cells, and blood vessels and is mainly controlled through ECM proteins and secreted factors.

4.Postoperatively, quadriceps strength  decreases by 62%.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1167681/)

5.Voluntary activation  decreases by 17%

6. Maximal cross-sectional area  decreases by 10% in comparison with the preoperative values.

7.The existing evidence suggests that patients lose approximately half of their preoperative quadriceps strength in the first month after surgery.

8.The results of preliminary studies have confirmed that reduction in muscle activation contributes substantially to early postoperative weakness

9.The associated swelling/Edema doesn't realy go away because of slow  vascularity as a result of  natural operational trauma and poor mobility and resulting poor muscle contraction. This swelling also lead to feeling of tightness.

10 .So in totality the stiffness in result of three things ,foreign body in place,Swelling and Poor muscle functioning. AND ALL OF THEM OR THEIR EFFECT IS TEMPORARY ONLY

REMEDY IS

1.Isometric quadriceps ↟

2.Elevation and Quadricps static every one hour

3.Ice therapy every one hour initialy till one week,then every two hours.(ICE IS BETTER THAN GEL PACKs)                     

                                         
4.Ankle foot movement in lying position

                                                 

5.Heel Raises in Sitting position

                                                 

                                                                  THANKS 😊