Is it just me, or does it seem like everyone is getting knee replacements lately? Ok maybe not everyone is getting them but I have patients in their late 40’s and early 50’s with total knee replacements. The procedure does not seem to be reserved for little old ladies anymore. With the advancement of technology which allows people at younger ages to qualify and the tidal wave of baby boomers do you feel totally equipped to handle pre and post knee replacement patients?
If the answer is no, then keep on reading to find out my top ways we can help educate and treat these kinds of patients.
- Pre-Surgery Education…I think this is an area that can really help chiropractors solidify in their patient’s mind the importance of having us as part of their healthcare team. I think traditionally one of the areas that the medical community has been lacking in is patient education. I believe chiropractors excel at this because quite frankly we have to so patients understand what we do and continue to be seen by us. All that to say, don’t forget to ask your pre-surgical patient if their medical team told them their prognosis and what to expect in recovery. If the patient answers “no” here are a few helpful tips:
- There really is no such thing as too much ice. 20 mins on/20 mins off over and over again. It doesn’t just reduce swelling but to also prevent bruising from their ankle to hip.
- Particularly for women patients: have them consider getting a booster seat for the toilet. It will aid in their ability to stand back up.
- The caretaker: the caretaker should really be bigger than the person having the surgery to assist with getting up and down, potential falls, etc. If the caretaker is not bigger than the patient they should strongly considering having someone else help with the post-surgical process.
- Purchasing a wedge to place under the legs while they are laying down to help improve drainage.
- Compression socks: these come standard from the hospital but do patients know they will have to be wearing them almost continuously for a few weeks post surgery?
- Do they know for sure their insurance will cover both the surgery and the physical therapy?
- Do they know how many weeks they will need physical therapy for and if they have a standing or some form of physical job how long will they be off?
- Post-Surgery Thoughts: I have two main ways I adjust which are using Palmer Package (diversified) and Activator Methods. Regardless of the technique(s) you use, chiropractic by nature is affecting the neurology of our patients. There can be one potential big issue with this for about a month following surgery. The issue is the medications the patients are on to control the pain and the muscle spasms.
I just learned this at a recent seminar I went to, check this out.
Here are some substances that do affect neurology and some that don’t:
Alcohol: No
Aspirin: Yes (especially in high doses)
Opiods/Narcotics: Yes
Acetaminophen: No
Ibuprofen: No
Marijuana: Yes
Tranquilizers: Yes
I think for us, knowing the medications that our post surgical patients are on is vital when it comes to us treating them. I had no idea that aspirin could knock out reflexes.
The other component to the post-surgical idea is, comforting your patients with the thought that their new knee does not need to be touched, looked at and/or adjusted for at a least a month following surgery. However it would still be wise for them to continue chiropractic care after surgery because gait is immediately affected once they become weight bearing again.
- Places to Adjust: clinically I was told by chiropractors who have been doing this way longer than me said to check for pubic bone and anterior sacrum following post knee surgery due to the altered gait.
What do you find is essential when treating knee replacement patients?
Kassandra Schultz D.C
