Guest guest Posted October 26, 2006 Report Share Posted October 26, 2006 I am planning to treat a patient who has had total knee replacement in both knees. He never regained normal ROM, and has been very stiff. I don't have alot of info on this patient yet, but I was wondering if anybody had some general info. on treating this problem. What would cause a failure of this normally succesful surgery? General prognosis of with acupuncture treatment. References? Any input is appreciated. Jason Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 26, 2006 Report Share Posted October 26, 2006 Hi Jason, > I am planning to treat a patient who has had total knee replacement in > both knees. He never regained normal ROM, and has been very stiff. I > don't have alot of info on this patient yet, but I was wondering if > anybody had some general info. on treating this problem. What would > cause a failure of this normally succesful surgery? Muscular atrophy of disuse is common after prolonged pain & /or joint replacement. Assuming that the artificial joint has not mechanical/engineering faults that limit ROM, IMO the most likely cause of poor knee ROM is weakness / atrophy of the muscles between the hip area and knee/patella/tibia, esp the anterior thigh (extensor) ms. > General prognosis with acupuncture treatment. IMO, if m atrophy / weakness is involved, one could expect some improvement of knee ROM to AP alone at weekly intervals for 6-10 weeks but improvement would be slow. IMO, supplementing AP Tx with daily use of TENS on 4 linear circuits (ant thigh, lat thigh, post thigh and med thigh), + TP therapy, + daily thigh & knne area massage (preferably with Tiger Balm or Moov rubs) + knee ROM exercises should maximise the chances of improvement. > References? Had not time to look. Best regards, PS: If the surgeon damaged the motor or sensory nerves to the knee area, the prognosis would drop, but even peripheral nerve paralysis can respond to Tx similar to that mentioned above. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2006 Report Share Posted October 27, 2006 Hi Jason, I've treated a few patients who had ongoing stiffness and pain following partial and whole knee replacement surgeries. Some of them I treated several years after their operations, and some fairly soon after. I found that my patients who were rigorous about doing their physical therapy exercises regained their full ROM, while those who slacked off did not. Exercising helps keep things from freezing up and adhering. I think it's fair to extrapolate that patients who were fairly active before the surgery would heal better than those who were not. I got great results with local needling of as many acupuncture points around the knees (including the ones behind the knee) as seemed relevant. Stiffness was remarkably better right after the first treatment, and pain was also reduced. I did not need to see these patients, all of whom were elderly, for many visits either. To my surprise, this was fairly easy to treat with great results and tons of patient satisfaction. --- jayburkelac <jayburkelac wrote: > I am planning to treat a patient who has had total > knee replacement in > both knees. He never regained normal ROM, and has > been very stiff. I > don't have alot of info on this patient yet, but I > was wondering if > anybody had some general info. on treating this > problem. What would > cause a failure of this normally succesful surgery? > General prognosis > of with acupuncture treatment. References? > > Any input is appreciated. > > Jason > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2006 Report Share Posted October 27, 2006 Hi All, & Andrea Beth, wrote: > I got great results with local needling of as many acupuncture points > around the knees (including the ones behind the knee) as seemed > relevant. Stiffness was remarkably better right after the first > treatment, and pain was also reduced. I did not need to see these > patients, all of whom were elderly, for many visits either. To my > surprise, this was fairly easy to treat with great results and tons of > patient satisfaction. I see problems after joint replacement more often in elderly post- menopausal people. My approach to AP in these cases includes Tx of the whole person. One must consider (and Tx if needed) KI deficiency in those cases. As well as local points, I include points for weaknesses in other organs / systems. Points like BL11, KI07, BL23, SP06 and LV03. I add points (and other advice) for other presenting signs, such as poor sleep, worry, etc. Optimum ROM depends on optimum function of the muscles and support- structures that control the affected joint(s). I agree that regular exercise is very important for people after hip / knee replacement, and that acupuncture can help, especially for pain and ROM. IMO, regardless of effective pain control, people or animals with muscular atrophy cannot regain optimal joint Fx and limb strength until the muscle- mass and strength becomes more normal. This is why I advise use of TENS, exercise, massage, etc, as suggested in my earlier mail. Best regards, Quote Link to comment Share on other sites More sharing options...
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