RANGE OF MOTION

Range of Motion (ROM) is the measurement of the amount of movement of a joint.  I am referring specifically to ROM for knee joints here.  A goniometer (see picture below) is used to measure ROM.  It is a metal or plastic handheld device with two arms which works like a protractor.  So we can easily use a protractor which can be found in most homes to measure ROM.

Pain, swelling and stiffness are common symptoms of arthritis.  If we suffer from these symptoms for many years, our ROM would be greatly affected.  In serious cases, the limitation of the ROM may impair our functions and our ability to perform normal daily activities.

My ROM before TKR had already been affected.  I was only able to squat maybe halfway down.  Today, after almost 16 months post my bilateral TKR, I finally measured my ROM with a protractor and it's around 120 degrees.  If my knees weren't so fat, maybe I could bend a little more.  I know that my ROM now is the same as before TKR because the degree that I could bend and cross my legs while sitted is the same as before.  When I saw my OS for a follow-up check at two weeks after TKR, he examined my knees and said that my ROM was 90 degrees.  At three months, he said my ROM was 110 degrees.  Then he told me that I had to achieve maximum ROM within six months after TKR otherwise, it would be difficult to improve further.   When I complained to him about the stiffness and tightness, he told me that its due to muscle scarring.  He said that when muscles are scarred, they will always contract.  And he also told me that the more ROM I achieve, the better the stiffness would be.  Well, after months of trying at my own pace, I found that my ROM could not improve any further.  And my stiffness is still there (see post on swelling and stiffness).

I raised a question to my TKR forum members whether ROM can still improve in advanced recovery.  And to my surprise, they said Yes!  Some of them discovered that they still see improvements even after more than a year of recovery without doing anything much.  So that was a relief to me  and I stopped worrying about trying to increase ROM.  One day recently, while I was doing something, I suddenly noticed that my knees could bend a little more than before.  I thought that was a pleasant surprise.  It's strange that sometimes when we stopped trying and worrying, then something unexpected but positive happens.

From my TKR forums, I noticed that a lot of members are very concerned about their ROM in early recovery.  In fact, some are so impatient about it and would work their butts out. Then they will complain why their knees are so painful, swollen and stiff.   Yes, it can be very painful and the PT's mantra is "No pain, No gain".  But this concept is causing a lot of pain, swelling and stiffness which will eventually lead to a delay in recovery.  It can be an emotional trauma too for most people and that's why PTs have earned the name "Physical Terrorists". 

It's also quite typical that most people can achieve more ROM when they work very hard with a PT.  But the minute they go home, they find that their ROM has reduced and so, they feel disappointed.  This is because their knees have become swollen and stiff as a result of working too hard. So if you have a chance to choose your own PT, I would suggest that you choose one that is more caring and compassionate.  After all, we are not training for the Olympics.  Recently, I learnt that some people hardly do any PT and they ended up fine with reasonably good ROM.  So that's another interesting discovery. Well, I am glad that I did not have to go through this because I only had the PT at the hospital for a few days.  After that, I just did it on my own at home.  I did not pushed myself too hard.  I just did the exercises up to the point of discomfort.  So I did not suffer from prolonged pain and swelling and as a result, I had a reasonably fast recovery.

Contrary to the usual "No pain, No gain" mantra, our Bone Smart Forum's mantra is "No pain, More gain". The rationale is that this will lead to faster recovery.  All we need to do is rest, ice, elevate and take pain meds accordingly.  One important thing I learnt from this forum is that our knees are in charge in terms of the healing process, not us.  So if we become impatient and overwork them, they will be very angry and we will face a set back in recovery.  But if we do our physical therapy exercises gently at a slower pace and give our knees a lot of TLC, naturally they will heal faster.  I believe that once our knees are stronger and the wounds have healed quite a bit, then we can start to do more intensive exercises to gain more ROM.  It will not be too late as a lot of us are living proof of that.

PT & MASSAGE AFTER TKR

Physical Therapy (PT)is primarily concerned with the remediation of impairments and disabilities and the promotion of mobility, functional ability, quality of life and movement potential through examination, evaluation, diagnosis and physical intervention carried out by the Physical Therapists (Wikipedia).

After TKR, most of us are subjected to physical therapy to help with the improvement in range of motion and strengthening of the muscles. PT can be a very painful experience and if we worked too hard, our knees become more stiff and swollen afterwards. And this will cause  delay in recovery as experienced by many TKRers.  I feel that PT is necessary but it should be done gently and at our own pace as the wounds from the surgery needs healing, not beating up.

In my home country, outpatient rehab is not very popular. I was taught to do some PT exercises at the hospital and was advised to continue doing them at home after I was discharged. I was so glad that I did not pushed myself too hard when I did the PT at home. I did it gently twice a day, sometimes once and sometimes, I had even forgotten to do it. I believed that because of this, I did not suffer from prolonged swelling and stiffness due to the swelling.  In fact, my rate of recovery was quite fast. It was only when my knees felt better and stronger, then I started to exercise more intensively and my range of motion improved gradually.

Massage is described as the manipulating of superficial and deeper layers of muscle and connective tissue using various techniques, to enhance function, aid in the healing process, and promote relaxation and well being (Wikipedia).

Besides PT, I believe that we should consider doing massage as well. I understand that massage after TKR helps to speed up recovery. It helps to move the fluid and get the scar tissue moving, reduce pain and increase range of motion. I also understand from one expert in muscles that after TKR, we should massage the entire thigh area, front and back. This helps to reduce stiffness at the knees and improve range of motion.

In general, massage is good for us.  I enjoyed doing body massage all along as I would feel very relaxed and re-energised afterwards. Some people like traditional massage that uses lots of strength when applying pressure which can be very painful. I prefer the more relaxing massage because its very therapeutic for me.

Among some of the benefits of massage are:-

· Improve blood circulation

· Promote tissue regeneration and reduce scar tissue

· Reduce anxiety, tension and fatigue

· Produce endorphins, a natural feel good drug

· Enhance immune system

· Reduce body aches and pain

· Reduce stiffness and improve range of motion

· Improve sleep quality 

Going for regular massage can be quite costly. But we can minimise it by massaging ourselves particularly on areas that we can easily reach.  I do this every night while watching TV, so it has become a routine.  Occasionally, I will go for massage by a professional massage therapist.  There are many techniques of massage but there is no evidence of which one is the most effective.  You can google to check out various techniques of massage and how it is applied.  Try out some of them and see which one works for you.

Here's something to share with you. I discovered a website and video by Heather Wibbels, a Licensed Massage Therapist which is interesting and may be beneficial.

Click this link below to go to her website.

http://www.massagebyheather.com

Click this link below to watch her video on scar and adhesion massage to loosen tissue and help range in motion which we can do ourselves.

http://www.youtube.com/watch?v=1vMvAJYikxo

 

Click this link which is contributed by a BoneSmart Forum member in relation to lymphatic drainage for faster recovery after surgery.

http://www.fortcollinslymph-massage.com


Click this link below to watch a massage on the thigh area.

http://www.youtube.com/watch?v=y_DwyZyozhA

WATER & ARTHRITIS

In our quest for better health, most of us will resort to consuming any health supplement that we hear is good for our body.  But we tend to forget that one of the most basic thing that our body need is water. Yes, plain old water which is freely available and cheap.  Most of us are quite dehydrated and we don't even realise or think much about it.  We all seemed to know that water is good.  But how many of us will consciously drink enough water to hydrate our body and how many of us are aware that dehydration can cause diseases including arthritis?

Some time ago, I discovered a book called "Your Body's Many Cries for Water" written by the late Dr. F. Batmanghelidj who had spent many years researching about dehydration which is most enlightening for me. His research revealed that unintentional dehydration produces stress, chronic pains and many degenerative diseases.  I have also done some research on dehydration and personally experienced the benefits of increasing water consumption drastically.

I learnt from the book that our body consist of 25% solid matter and 75% water.  Our brain tissue is said to consist 85% of water.  It is the water that energises and activates the solid matter.  Even our blood contains 50% of water.  So if we are dehydrated, our blood becomes more concentrated.  In simpler term, it means that our organs need water to function and if we don't consume enough water, our organs cannot function properly and eventually, we start to have symptoms such as pain.  If we ignore the symptoms, then the condition will become worse. 

Some of the symptoms of dehydration includes the following:-

• Headache                                       Dizziness 
• Fatigue                                           Excessive thirst
• Dry mouth                                      Muscle weakness
• Lack of urination                             Constipation
• Dry skin                                         Muscle cramps
• Kidney problems                             Migraine

After learning about the importance of water, I increased my water consumption drastically as I  wasn't drinking enough water in the past. I have been drinking from a bottle so that I know how much water I consumed.  I can drink lots of water at home but going out is a problem.  When I am working in my office, I tend not to drink enough water because of the busy work schedule.  Sometimes, I ended up having headaches when I reached home and I realised that I did not drink enough water at the office.  So I quickly grab my bottle of water and gulped down lots of it.  After a while, the headache was gone.  Its amazing.  I would not have thought about this in the past and I would have swallowed some medicine for it.  But now, I know that the problem was just dehydration.  So the next time any of you have headaches, migraine or pain, try increasing your water consumption drastically and see whether it works.  It could just be a thirst signal.

Another interesting thing I learnt is that our cartilage surfaces of bones in a joint also contain water.  The lubricating property of this "held water" is utilised in the cartilage, allowing the two opposing surfaces to freely glide over one another during joint movement.  Therefore, water lubricates our joint and dehydration can cause joint problem.  Wish I knew about this much earlier.

So the next question is how much water do we really need to drink?  It is recommended that the daily intake of water should be within 2 - 4 litres depending on the size of the person.  The bigger we are, the more water we require.  The more active we are, the more water we need.  Don't forget that we also excrete a lot of water through perspiration due to exercise or heat, urine, bowel movement, sweaty palms or feet and breathing - yes, our lungs expel water through normal breathing and even more during cold weather.

Alcohol, coffee, tea and beverages containing caffeine are not counted as water.  A good indicator for water requirement is the colour of urine.  A well hydrated person produces colourless urine.  A comparatively dehydrated person produces yellow urine.  A truly dehydrated person produces urine that is orange in colour.  Of course, there are concerns about drinking too much water.  Though this is uncommon but those with certain medical conditions should seek their doctors' advice first.

Now some of you may have heard about the benefits of lemon.  Lemons are antiseptic, has excellent digestive properties, cleanses and stimulates the liver and kidneys, good for relief from cold and flu symptoms due to its Vitamin C contents and great as a skin cleanser.  Lemons have been shown to be helpful for reducing some of the symptoms of osteoarthritis and rheumatoid arthritis. They are acidic in its basic state but because of its very low sugar content and high alkaline mineral content, lemons actually have an alkalising effect on the body.  So its good to drink water with lemon.  We could just drop a slice of lemon into our water or squeeze the juice into the water.  I have a slice of lemon in one of the bottle which I drink daily.  There are also claims that lemon can kill cancer cells.  How true is this?  I really don't know but if its true, then it will be a bonus for us.  Anyway, I would continue drinking water with lemon simply for its natural health benefits.  On top of that, they are tasty, refreshing and inexpensive.

We all know that exercise is good for our body. And I also learnt that exercise makes the muscles hold more water in reserve and prevent increased concentration of blood that would otherwise damage the lining of the blood vessel walls. Fat holds less water than muscles. So this gives us another reason to exercise. 

In  summary, I feel that water and exercise are two important factors for good health and they don't burn holes in our pockets too.  So lets drink up!

MY ADDICTION TREATMENT

GENERAL OVERVIEW

If you have read my post on addiction, you may be interested to read about my experience in rehab.  Though it has been many years but I still have vivid memories of my experience there. 

It was a 28 days program at the treatment centre.  If you have seen the movie called 28 DAYS starring Sandra Bullock which is my favourite movie about addiction, you would have some idea of the concept of such treatment centres.  28 days might seem very short but for me, it seemed like an eternity and the amount of things that happened during this period were unbelievable.  I have seen the effects of addiction resulting in bipolar, schizophrenia, hysteria, verbal abuse and some really bizarre behaviours.  It was really an eye opener for me.

The drug of choice for addicts seeking treatment at the centre includes heroine, alcohol, gambling, sex, overeating and some other types of drugs.  Heroine was the most popular followed by alcohol.  Cross addiction was also very common.  It means being addicted to more than one drug.  I learnt that drugs and alcohol has different effects on different addicts.  If the drugs or alcohol makes the addicts very active, then they will have problem sleeping and so they will consume sleeping pills. On the other hand, if the drugs or alcohol acted as downers for the addicts, I learnt that some will resort to caffeine to keep themselves awake the next day for work.  There was one alcoholic who was also addicted to caffeine because she consumed huge amounts of coffee to keep herself awake at work.  And she eventually suffered a severe headache as the withdrawal symptom.  

There was one person who was addicted to alcohol and gambling.  He told me that when he was gambling, he also consumed lots of alcohol.  After that, he was so high that he can't remember what happened before he collapsed.  When he woke up the next day, the first thing he did was to check his ATM receipts and was shocked to find out that he had made several withdrawals.  Another addict with overeating disorder will spend a lot of money on junk food and alcohol and consumed everything at one go.  Then she will poke her fingers to the back of her throat to make herself puke.  This action resulted in multiple scars on her fingers.   I met another addict who was a doctor and he relapsed after 20 years which just goes to show that no one is exempted from relapse.  He was addicted to heroine and because of his job, he had access to the drug.  It just took one moment of vulnerability for the relapse.  I also learnt from one sex addict that he would comb the streets every night in his car looking for hookers. He was also addicted to gambling and he already had a fiance. 

Many incidents happened at the centre.  One addict became hysterical.  Another addict who also has bipolar would just suddenly burst out in verbal abuse and seemed capable of beating someone up. So because of the danger that he could cause to others, he was kicked out from the centre.  Some addicts were forced to be admitted into the centre by their families thereby causing lots of denial and behavioural problems.   There were also incidents of some runaways, some who smuggled drugs into the centre and some who literally just checked into the centre for some sort of holiday or break without serious thoughts of recovery. 

I cannot forget one middle aged lady who was always dressed in a prim and proper manner.  She was so arrogant, rude and defencive.  I found it amusing that she always claimed that she is not an addict and that she does not need any help.  She said that the only reason she came to the centre was that she was forced by her children.  She also claimed that she was clinically depressed and that anti depressants were her saviour.  One day, when we had a lecture on depression, she openly disagreed with the lecturer that drugs can cause depression.  She took it so personal and ended up arguing with the lecturer and subsequently, walked out of the room.  She hated everyone.  She even told me directly that she did not like me because I was bold enough to speak up about her untoward behaviour in group.  Well, I did not have to get angry with her for long as she was thrown out of the centre.

There were just too many other incidents and experiences to describe here.  But despite all the things that happened in the centre, life goes on.  We have a strict program to follow under the supervision of the nurses and counsellors who were recovering addicts and they were excellent at their job.

OSTEOARTHRITIS

Osteoarthritis (OA) is the most common joint disorder affecting mostly weight bearing joints such as hips, knees, ankle and foot.  The problem starts with the deterioration of the cartillage which is a firm, rubbery tissue that cushions our bones at the joints and allowing bones to glide over one another.  When the cartilage  deteriorates, the bones rub together causing pain, swelling and stiffness.  Eventually, this will cause bony spurs to be formed around the joints and subsequently, the ligaments and muscles around the joints become weaker and stiffer.

One of the reasons that caused OA is that it runs in the family.  Well, this is certainly true in my family as my parents and a majority of my siblings have OA.  Obesity is another factor that leads to OA due to the burden of the weight on the joints.  So I guess I have a combination of both.  Other factors include injuries from sports, jobs that require a lot of standing, squatting and lifting, direct impact on the joints such as football, basketball or any other sports that have jerky movements.

Pain, swelling and stiffness are the most common symptoms in OA.  Most people will experience morning stiffness and stiffness after a period of sitting, standing, walking or exercise.  During the early days of OA, after a good night's rest, my knees would feel better the next day.  As the condition got worse, I have to rest and take pain meds as well for relief.  I also experienced tenderness when pressure is applied to areas around my knees and legs.  Towards the advanced stage of the joint damage, I suffered the pain and stiffness even when I wasn't moving.  Pain medication doesn't work anymore and it affected my movements and sleep tremendously. 

In the past, I have tried arthritis cream, medicated plasters, massage and injection of artificial joint fluids which gave me a temporary relief of the pain.  I have heard about acupunture and some non-invasive treatments but I have not tried any of them.  However, I have tried treatments by one qi qong master and it was quite good particularly for blood circulation. I have also taken supplements like glucosamine and chondroitin sulfate.  From time to time, I had to take pain medication as well.  These were all helpful to me for pain relief until my OA progressed to a severe stage, then I found that nothing works anymore.

X-ray is the best way to know the extent of joint damage.  My Orthopaedic Surgeon (OS) said that there are 5 stages for joint damage, 5 being the end stage.  My joints were at stage 4 when I had my TKR and the pain was already unbearable for me.  So I can't imagine how one can reach stage 5.  Knowing the extent of our joint damage is a good thing because we can be more prepared and take necessary action such as changing our lifestyle.  This is an area I feel that some of us would hesitate to do.  Its like we are in a state of denial and not knowing the truth is better as it would not require any change.  I have been a culprit of this until I realized that I have to face the reality and do something about it. 

During the initial period of my recovery from sleeping pill addiction, I changed my lifestyle.  I started to exercise and eat healthily.  Some people think that with OA, we should not aggravate it by doing exercise.  In fact, some will try to avoid walking too much just to preserve their knee condition.  But the reality is that if we dont exercise or be active, we lose our range of motion and our joints will deteriorate even faster.  I find that whether I exercise or not, the pain and stiffness are still there.  So it would be more beneficial if I exercise as it improves joint movements and at the same time, I feel healthier, happier and have a positive mindset which really helped me to manage the pain better.  I was surprised that besides my regular exercise, I would gate crash running competitions which my children and sister participated in, just by walking after everyone has taken off.  I have walked from 5 to 7 km in such competitions which is something that I have never done before.  Even though my knees would end up so sore, stiff and painful but the sense of achievement I get when I reached the finish line makes it all worth it.  All these physical exercises kept me motivated and actually helped me to last about 10 years before I had my bilateral TKR.

The key is that when pain meds and all of those non-invasive treatments doesn't work anymore and we continue to be in a great deal of pain and stiffness, then it is time to consider TKR.  TKR requires a lot of courage and I realized that it is hard to overcome the fear for a lot of people.  After my experience with TKR, I have great admiration for elderly people who have gone through TKR.  They would have faced more challenges and difficulty than younger people but inspite of that, they overcame all of it.  They might have taken longer in rehab too but in the end, they still get to enjoy the benefits of a successful TKR.  So in order to make a change for ourselves, we need to let go of the fear.  Because ultimately, the change will give us pain free knees and a better quality of life.

Here are pictures of a normal joint and a joint affected by OA obtained from the internet.



Normal Joint

Arthritic Joint

MY ADDICTION LIFESTORY

I used to sleep like a baby before I developed Osteoarthritis (OA) in my knees.  However, after suffering from knee pain for some time, I started having sleep problems.  Not only was I disturbed by the pain in the knees but also the stiffness when I sleep.  So I started to take sleeping pills and it seemed to solve my problem.  The next day I would wake up after a good sleep and my knees would feel better already.  Then the pain and stiffness comes back after moving about the whole day.  Initially, the sleeping pill seemed like a wonderful solution.  But after a period of time, I had to consume more and more to get the same effect.  Eventually, I became addicted to it.

In the past, I wasn't active especially during the years when I had to take care of my children while having a full time job.  When I had OA, I naively thought that I should not move too much so that the condition of my knees would not be aggravated.   During my active addiction with sleeping pills, I became depressed and isolated.  I put on so much weight that my belly looked like I was 6 months pregnant.  I started to lose my mind as I could not think straight nor make any simple decisions.  Then I started having symptoms like seeing dots on the television screen.  I started to panic and decided to stop consuming the pills.  During this time, I had already stopped working and started to go to the gym thinking that I needed to do something healthy.  The day I stopped taking the pills, I went to the gym and I had a seizure attack at the car park and collapsed beside my car.  I was rushed to the hospital and when I woke up, my family members were there.  I was told that I had a seizure and the doctor had calmed me down with some Valium.  I was so fortunate that nothing happened except that my shoulders were hurt due to the fall.  So I stayed at the hospital for observation and was discharged after two nights.

After 3 months, I relapsed.  This time, it was worst.  Within a short period of time, I was consuming a high dosage of the sleeping pills and I started to develop all the same symptoms.  My husband was suspicious of my addiction and I finally confessed to him and gave him all the pills that I had in my possession.  In fact, he was worried about me just giving up totally instead of gradually.  That night, I had a seizure again on my bed and my husband saw the whole episode which left him scarred for some time.  My sisters helped to call an ambulance and I was rushed to the hospital again.  After some medical tests, the doctor told me that I had elevated sugar, cholesterol and blood pressure.  I knew something had to be done but I was lost.

After I was discharged, my family intervened and they found a treatment centre overseas as there wasn't any locally.  I agreed to go there and totally surrendered myself.  Going to this treatment centre was the best decision ever.  It saved my life.  I began to understand my addictive behaviours and also found that the root cause of my problem was due to my knee pain.  I also discovered that when a person consumed a high dosage of sleeping pills and stopped suddenly, the body will experience a seizure which is the withdrawal symptom.  And that was what happened to me. 

During my treatment, a program was drawn up for me. It was based on a NA 12 steps program. There were lots of lectures, family/group counselings, self improvement, relaxation activities etc.  I had to do a brisk walk every morning and was put on a low fat diet.  It was very tough initially because I was so unfit and overweight.  But I improved gradually and in the end lost quite a bit of weight.  My belly was gone and my health conditions improved tremendously.  There was one day, when we hiked up a hill which was quite tough but when we reached the top, there was a huge rainbow across the sky.  All of us just stood there to suck up the whole environment.   Just then, an overwhelming emotion struck me.... I felt so great to be alive! 

During the 28 days at the treatment centre, I learned so much and graduated with flying colours. My sister in law even brought a tape for my farewell at the centre and the special song was called "Wish me luck and wave goodbye to me".  I think its from the thirties but it was so apt.  So the next step my Counsellor said was for me to decide which road I want to take - road to recovery or relapse?  Of course, I chose the road to recovery because without recovery, I would lose everything that is important to me.    You know, I realised that one of the best thing during my early recovery was to have my mind back.  You can imagine the relief I felt after what my mind has gone through.  And there is one celebrity who summed it all up by saying ... "Of all the things I lost to addiction, I miss my mind the most".

BOW LEGS & KNOCK KNEES

Do you know that children up to a few years old have some degree of bow-leggedness?  They do and its due to the time they spent in the cramped space in the womb.  Usually, babies have a bigger space between their knees and the soles of their feet face each other.  When they start to walk, they may appear to be bowlegged.  However, it gradually straightens after they can walk steadier and the legs begin to bear their weight.

However, if the bowleggedness remains after the child has grown up, then it becomes a deformity.  There are a variety of reasons for such deformity which includes Blount's disease, improper nutrition, sickness such as rickets caused by vitamin D deficiency, physical trauma etc.   Eventually, this will lead to difficulty in walking and early onset of arthritis.  One of the long term effects of Osteoarthritis (OA) in adults is bowlegs (vargus) or knock knees (valgus). 

 

When the surface of our joint is damaged due to the deterioration of cartilage, there is imbalance in the joint.  To describe it in another way (a very good analogy given by a medical professional), it is like a camping tent.   A tent is held by poles (bones) and guy ropes (muscles and ligaments) and pegs in the ground (their attachment on the bones).

If the surface upon which they depend on stability becomes out of balance, then the whole structure will lean over. This is exactly what happens to our knee joints.  The imbalance will cause deformities depending on which side the joint leans over.  If it is on the lateral side, it is called bow legs and on the medial side, it is called knock knees. And this state of collapse causes the muscles and ligaments to become slack and tight. Eventually, the muscles and ligaments become inflamed, sore, tight and painful.

My friend who had a bilateral TKR a few years ago used to have normal legs until she had OA.  Eventually, her OA worsened until her legs became seriously bowlegged leaving her with a great deal of pain and difficulty in walking.  As a last resort, she gathered her courage to go through a bilateral TKR.  In such a situation, both knees would have to be done at the same time otherwise, the operated leg would be longer than the other making things more difficult.  After TKR, both her legs were straightened and she is pain free from the knees and enjoying a better quality of life.  However, because of the delay in surgery, the damage has greatly affected her range of motion.

When I consulted with my Orthopaedic Surgeon (OS) about TKR, I was told that I have knock knees.  I thought my legs looked very straight but apparently, it is not normal.  He explained that normal legs have a certain degree of curvature from the knees downwards.   When I went back to look at my x-ray, I observed that the cartilage loss was in the medial side so it explains the knock knees.  And so my OS corrected the alignment of my legs during TKR.  Actually, I felt strange with the new alignment as both my feet could not touch each other when I stand now maybe its due to my fat knees.  I still feel strange looking at my legs in the mirror but my OS said that they are normal now, so I had to believe him.  Guess it takes some time to get used to it.

It is important to know that if we wait too long to seek treatment for OA especially if it has already resulted in bowed legs or knock knees, we will be left with a lot of damage caused by OA and there may be insufficient quality of bones to hold the implants.  So again, the earlier we seek treatment, the better.

Here are some pictures obtained from the Internet showing the x-ray and pictures of an elderly woman with bow legs due to severe arthritis before and after bilateral TKR.   What an amazing transformation!  Her courage is really admirable considering that she did this in her 70s or early 80s.  I hope this is a good inspiration to the rest of us.

X-ray of a bowed leg before & after surgery

 

 



Bowed legs before surgery

 

 

 

 



Legs after surgery