Understanding the Case

Knee Pain: Initial Assessment and Diagnosis

When our patient first sought medical attention, she was struggling with bilateral knee pain that had been gradually worsening over several months. Like many people her age, the pain had become so severe that it was significantly affecting her daily activities. Simple tasks that most of us take for granted—walking to the bathroom, climbing stairs, or even standing up from a chair—have become painful challenges.
After thorough evaluation and relevant investigations, she received a diagnosis that’s common among older adults: bilateral osteoarthritis of the knees. Osteoarthritis develops when the protective cartilage that cushions the ends of your bones wears down over time, resulting in pain, stiffness, and decreased joint function.
For this patient, conservative treatments were no longer providing adequate relief. After careful consideration of her overall health status and quality of life, the decision was made to proceed with bilateral total knee replacement surgery

Managing Bilateral Knee Pain Through Surgical Intervention

On November 7, 2024, our patient underwent robotic bilateral total knee replacement under epidural and spinal anaesthesia. This advanced surgical approach uses robotic assistance to help surgeons achieve more precise implant positioning and alignment, which can lead to better outcomes.
The surgery itself was just the beginning of her recovery journey. Immediately after the procedure, she was placed on epidural infusion for pain relief, which continued for three days. Cryotherapy (cold therapy) was also implemented to help manage pain and reduce swelling in the surgical area.
During her initial post-operative assessment, the medical team noted that she was conscious, cooperative, and well-oriented. Her vital signs were stable, though she did have bilateral pitting oedema (swelling) in her legs, which is not uncommon after this type of surgery.

Physical Therapy for Knee Pain: A Structured Rehabilitation Approach

A well-designed physical therapy for knee pain program is essential for successful recovery after knee replacement surgery. For our patient, rehabilitation began with a comprehensive assessment of her condition and needs.

Initial examination revealed:

• Tenderness around the surgical sites
• Muscle strength of only 2/5 in both knee muscle groups (indicating significant weakness)
• Limited active range of motion due to pain
• Passive range of motion of approximately 40 degrees in both knees

Based on these findings, the rehabilitation team developed a structured care plan with clear short-term and long-term goals:

Short-term Goals:

• Maintain muscle strength
• Lessen pain (as measured by the Visual Analog Scale or VAS)
• Improve range of motion
• Reduce tenderness

Long-term Goals:

• Improve muscle strength to at least 3/5
• Achieve active range of motion of 110-120 degrees
• Return to normal activities of daily living
• Walk without support

Elderly Patient Care: Special Considerations in Knee Replacement Recovery

Effective elderly patient care requires attention to details that might not be as critical for younger patients. For our 76-year-old patient, the care plan included:

• Vital sign monitoring every 8 hours to ensure stability
• Proper care of the incision site to prevent infection
• Position changes every 2 hours to prevent pressure sores
• Strict infection control practices, including proper hand hygiene
• Consistent medication administration

These measures are particularly important for older adults, who may have reduced physiological reserves and are at higher risk for complications like pressure ulcers, infections, and cardiovascular events.

Rehabilitation Goals

The Road Ahead: Continuing the Rehabilitation Journey

Recovery from bilateral knee replacement is not a quick process, especially for older adults. Our patient’s rehabilitation journey continues with ongoing:

• Strengthening exercises for the knee and hip muscle groups
• Range of motion exercises to improve flexibility
• Balance and proprioception training
• Functional activities to prepare for return to daily living tasks
• Gait training to improve walking pattern and reduce dependence on assistive devices

The rehabilitation team regularly reassesses her status and adjusts the treatment plan accordingly, ensuring that interventions remain appropriate and effective as she progresses.

Key Takeaways from This Knee Replacement Journey

This case illustrates several important aspects of knee replacement rehabilitation:

• Individualised Approach: Rehabilitation must be tailored to each patient’s specific needs, considering factors like age, pre-existing conditions, and functional goals.
• Progressive Programming: Starting with basic interventions and gradually increasing intensity and complexity is essential for optimal outcomes.
• Comprehensive Care: Addressing all aspects of recovery—pain, swelling, strength, flexibility, and function—provides the best foundation for success.
• Patience and Persistence: Recovery from knee replacement surgery takes time, especially for older adults. Consistent participation in therapy and home exercises is crucial.
• Realistic Expectations: While significant improvements can be expected, the recovery timeline varies, and some limitations may persist, especially in the early months after surgery.

For our 76-year-old patient, the journey from debilitating knee pain to improved mobility demonstrates the potential benefits of knee replacement surgery when combined with appropriate post-operative care and rehabilitation. While her recovery is still ongoing, the progress she has made thus far provides hope and motivation for continued improvement.

If you or a loved one is considering knee replacement surgery, remember that the procedure itself is just one step in the process. A committed approach to rehabilitation, guided by qualified experts, is essential for achieving the best possible outcome and returning to a more active, pain-reduced lifestyle.