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Dr. Andrew Rynne

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Undergone bilateral knee replacement, had prior spinal fusions and gastric bypass. Suggest exercises to release stiffness

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Dr. K. Naga Ravi Prasad

Orthopaedic Surgeon, Joint Replacement

Practicing since :1996

Answered : 2148 Questions

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Posted on Sat, 16 Nov 2013 in Bones, Muscles and Joints
Question: I am a 58 yr old woman, two weeks post op bilateral knee replacement. I have had 2 prior spinal fusions as well. Despite the amazing amount of drugs which include oxy codone slow release and immediate release, I am in constant extreme plain 8 - 9 on scale. I've always consered high pain threshold but this is insane pain. I'm doing pt, as well as trying to talk hourly to prevenet additioal stiffness, but its still crazy pain that cannot be releaved. Are there any exercises you could relay to me that may offer some additional releaf. The other concern is I'm a 8 year post op gastric bypass pt and realize that I do not digest some things as most. It was a Fobi pouch, similar to a roux n y. Could this have any part to play as to why the meds don't seem to work very well? Thanks you.
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Answered by Dr. K. Naga Ravi Prasad 21 minutes later
Brief Answer:
It takes a bit of time for the pain to resolve.

Detailed Answer:
Hi, thanks for writing to us.

As you are only 2 weeks post op BILATERAL TKR case, naturally pain tends to be on the higher scale than a person undergoing single side TKR.

Generally, the intensity of the pain will go on decreasing as the time passes off and by the end of 8 weeks after a TKR procedure, virtually every patient should be pain free. This is the normal course of pain after TKR procedure.

Excessive (Over vigorous) Physiotherapy is also to be blamed as the cause of severe pain in a few cases after TKR. As the soft tissues are still in the phase of healing within 2 weeks after TKR, Physiotherapy exercises should be done within the pain limits.

The clinical dictum is that whenever there is pain & inflammation in soft tissues, they should be rested.

Apply ice to the painful area after physiotherapy exercises. Ice will help calm the inflammatory response and stimulate blood flow to the area.

Before activities, gentle heating can help loosen the muscle. Apply a heat pack to the painful area prior to stretching or exercising. As a general rule of thumb, remember to heat before an activity and ice afterwards.

As most of the medicines that are consumed gets absorbed into the systemic circulation either in the stomach or the first part of duodenum, I suspect that the roux-en-Y gastric bypass might have been contributing to the malabsorption of the medicines that are being taken so as to reduce their efficacy resulting in lesser therapeutic response.

So, I feel in your case, injectable analgesic preparations may be a better choice. Approach your treating physician and discuss the issues.

Hope I have addressed your query. Happy to help further.

Regards,
Above answer was peer-reviewed by : Dr. Raju A.T
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