SWELLING & STIFFNESS

Pain, swelling and stiffness are symptoms that all of us suffer from when we have Osteoarthritis (OA).  The degree may vary depending on the severity of the OA.  When the cartilage wears off, the bones rub together causing pain, swelling and stiffness.  As a result, bony spurs may form around the joints and the ligaments and muscle
s around the joints become weaker and stiffer.  This causes a lot of pain and stiffness.  My joints pre-op had developed quite a number of bony spurs which my OS pointed out from my x-ray.  So you can imagine the degree of pain I suffered from the grinding of the bones and the 'poky' spurs.

Before TKR, I experienced stiffness after prolonged sitting, standing and walking.  Sometimes, I do experience morning stiffness too.  After TKR, I experienced stiffness during early recovery due to the swelling of the knees.  This is normal and will reduce after some time.

Swelling is caused by fluid.  When our knees have gone through a trauma especially after the surgery, our body will automatically send blood to our knees to protect and start the healing process.  With blood comes fluid which is also called lymph.  The excessive fluid may get trapped at the knees because there is insufficient space, like the pipe is too small to flow through.  That's why the knees are swollen.  So if we overdo physio therapy (PT) exercises, it will cause more swelling and stiffness.  PT is necessary but it should be done gently up to the point of discomfort and not up to the point of pain.  With pain, usually comes swelling and with swelling, we will naturally get stiffness.  And this will cause our knees to be stuck and they cannot bend.  That is why we are advised to ice and elevate our legs in order to reduce the swelling.

Some TKRers have seeked treatment to reduce swelling by doing a lymph drainage therapy which they found to be beneficial.  This is done by a professional massage therapist and there is a link below here to one website recommended by one of my TKR forum member.

I also have the feeling of a tight band around the knees.  I learnt that it is caused by scar tissue.  Apparently, when our OS cuts open the knee, he has to undercut the skin and superficial structures from that centre line to each side of the knee in order to get good access all round the bones.  Part of the healing process is when those flaps reattach themselves to the main body of the leg.  This healing creates a thin layer of scar tissue across the front and sides of the knee.  Scar tissue is not flexible compared to normal tissue so that's why it feels like a tightness or band across the knee especially if there is swelling and also during normal activities later on.  It seems that it will gradually reduce in size and thickness over a period of time up to a point when we might not feel the sensation anymore.

After more than a year, I still have the same stiffness after prolonged sitting, walking or standing.  I discovered that most members from the my TKR forums have the same experience with stiffness.   I often wonder why we still experience stiffness after many months of recovery as I do not have swelling even at 3 months after surgery.  Apparently, all the damage caused to the ligaments and muscles during the  progression of the arthritis process actually remains after TKR.  That's why we still have the stiffness.  Some studies have shown that:-

1.   Some people seem to make more scar tissue than others which causes stiffness.

2.   If the patient have stiffness before surgery, then it is more likely to have stiffness after surgery.

So TKR may give us pain free knees but it cannot remove the damage caused by OA.  It's the same case like my friend who went through a bilateral TKR and was able to get her bow legs fixed but her range of motion had been greatly affected due to the damage caused by OA. In order to prevent more damage from OA, we should consider doing TKR earlier. 

Anyhow, I can live with the stiffness as I have done that for many years during my OA days.  The most important thing is that I have two pain free knees and my overall function is not impaired.  And I am grateful that I can still lead an active life.

Here's the link for you to check out on lymph drainage therapy.

http://www.fortcollinslymph-massage.com