Knee surgery

I met an old friend today at the usual haunt, the coffee shop. He is my age, mid seventies, and has had left knee joint replacement, (tibio-femoral) three years ago. He was subdued about the success of the procedure - for those of us who have never had surgery of any kind, I believe we can never imagine the impact on our day-to activities that follows surgical intervention.

Many people feel a great relief from the cessation of pain - others, well, they often report a reduction in mobility, and a sense of frailty.

Let's discuss this latter group, including my friend at the coffee shop.

His concern was a reduction in mobility in the left knee joint - flexion was, immediately after the operation, limited to about 40 degrees; remember, this man and I were very active in our early years in mechanical and structural engineering, so our grasp of this aspect of his situation was quite clear. Medical scientists, who have a clear understanding of the methods, and the intricacies, of joint replacement, seem to have a poor view of the structural side-effects of their wonderful efforts.

Having adhered to the advice of the orthopaedic surgeon, which included the almost compulsory recommendation of physiotherapy, my friend returned to his daily walking and golf programme, and today, almost three years post-surgery, flexion is still limited to about 90 degrees, and when he walks, his paces are no more than one third of a metre.

After consulting the original surgeon three times, and another specialist in the next capital city for a second opinion - he was left with the forecast that: such poor results are not uncommon, you have an abnormally high degree of fibrosis. Either you learn to live with the situation, or, come back in year or so and we will slice through the tendon of the offending extensor muscle, to give some relief to your problem.

I propose to you possums reading this diary entry that some people just don't understand that fibrosis - excess scarring - is common; it is a natural adjunct to many forms of bodily invasion, such as surgery, radiology, and muscle tears. Such scarring limits movement of the joint(s) in the vicinity of the invasion, so that recovery can occur.

To propose surgery as a means of improving mobility is a contradictory thesis - surgery will only promote more scarring - this man needs a programme of stretch, either alone, or assisted, and much of the fibrotic tissue can be modified, and mobility enhanced.

I'm only an out-of-work engineer/lawyer kiddo's, but I know how this stuff works at a basic level - and that's manual therapy, massage science, my massage science, working at a basic,yet vital level.