The Post-Knee Replacement Swollen Knee Blues

by Rick DeTroye, LAc, MAcOM

The Post-Knee Replacement Swollen Knee Blues, Rick DeTroye L.Ac. LLC in Northeast Portland, OR

I hiked Hamilton Mountain recently, on an overcast, but beautiful Monday in August. The temperature was perfect, high 70's to low 80's, enough to work up a sweat, but not exhaustingly hot.  For those of you unfamiliar with Hamilton Mountain, it's located in southwest Washington, just east of Portland in the Columbia River Gorge.  The guidebooks list it as a difficult hike and I would agree with that, though it's not quite as challenging as other hikes in the Gorge (think Dog Mountain and Mount Defiance).  The hike that I do is about a 9 mile loop which has an elevation gain of 2000 feet, enough to let my 54 year old hips and knees know that they're 54 years old!

I always hike the trail counter-clockwise, which means I go up a series of steep switchbacks that snake through thickets of ferns, Douglas Fir and the dreaded Poison Oak.  On that Monday, the trail was nearly deserted.  However, as I neared Hamilton's summit, I bumped into a man and a woman, probably in their early 60's, who were headed back down the mountain.  We stopped and chatted for a bit and they mentioned that they had stopped short of the top because she was still recovering from knee surgery.  Being the curious practitioner that I am, I immediately looked at her knees and saw the tell-tale sign of a knee replacement: a single long, purple scar running down the front of her right knee.  The scar looked new and still healing in one small area. Trying not to appear too nosey, I gently inquired about the surgery.  As it turned out, she was only three months out from the procedure.  Three months out?  Wow!!  I was impressed! 

For those unfamiliar with knee surgeries, knee replacements tend to be very successful and are fairly routine procedures these days.  They're still, however, very invasive surgeries and it can take months for people to return to full strength and activity afterwards.  I was amazed to see her hiking Hamilton Mountain only three months after surgery, even if she DIDN'T make it to the top.  I have no doubt that given a few more months to recover, she would make it there without a problem.

As an acupuncturist, people usually seek me out when things AREN'T going as planned.  Although this woman was experiencing a rapid recovery, I tend to see people who are struggling to make progress after knee replacements. Most often, these folks are having substantial lingering pain, limited range of motion and significant swelling.  I've seen people as many as five months post-surgery who still have a hot, red and purple, swollen, painful knee.  They can't begin returning to their former level of activity and are worried that they won't ever be able to.  They can't sleep well because of the pain.  They're often frustrated, discouraged and fearful due to their slow progress.  They're tired of taking pain meds and anti-inflammatories, and using ice doesn't have much effect on reducing their symptoms.  They're hoping acupuncture might get them moving in a better direction.

In my experience, acupuncture can have an immediate impact on reducing the swelling, heat and pain that can plague post-surgical knees.  This is true of any type of post-surgical knee, but I've seen the most dramatic results with knee replacements.  Once the swelling and inflammation are reduced, a reduction in pain will follow and the range of motion can begin to improve. Though the degrees of outcome have varied, every knee that I've treated after a replacement has improved.  In some cases, the results have been dramatic.

People often ask how I feel about physical therapy.  I'm a believer in PT.  Like all modalities, it's important to search for a skilled physical therapist who has experience in diagnosing and treating the issue you're having problems with. In this case, the knee.  When it comes to knee replacements, acupuncture and physical therapy are tremendous complements to one another. Acupuncture treats pain and inflammation at a level that pain meds, anti-inflammatories and ice can't reach.  Once swelling is reduced and pain lessens, physical therapy treatment and exercises can be utilized more effectively and a person can progress more rapidly in rehab.

What about using acupuncture immediately after surgery?  Many physicians advocate the use of acupuncture for post-surgery pain and swelling.  In my experience, acupuncture is very safe and effective for post-surgery treatment, even immediately after a knee replacement.  Not too long ago, I received a phone call from someone who had just undergone knee replacement surgery and was recovering at home.  They were in a lot of pain which even strong pain meds couldn't touch.  I treated them at home using acupuncture points on their hands, arms and feet.  The pain decreased markedly after the first treatment, so we continued treatments for a number of days to ensure that the pain level stayed down.  The person was able to sleep and rest better as a result which helped them progress more smoothly through their bed rest and rehab.

In addition to acupuncture, I often include Chinese herbs and nutritional supplements during post-surgical treatment of the knee.  Chinese herbs are very helpful for reducing pain, heat and swelling.  Nutritional supplements might include Vitamin C, bromelain, turmeric and a high quality fish oil.  If the incision is fully healed, I might also suggest the use of a Chinese herbal compress to reduce swelling and promote the movement of blood and fluids through the tissue.  Ice may still be indicated if there are clear heat signs such as redness and feeling hot to the touch, but there are times when alternating hot and cold may be a better choice: ice will help reduce inflammation while heat will promote the circulation of blood and fluids.  In Chinese medicine, improving the circulation of qi, blood and fluids is vital and is the primary approach for reducing pain, heat and swelling.

Not everyone who gets a knee replacement will be able to hike up 2000 feet to a mountain top, even if they get acupuncture.  The success of surgery can also depend on other factors, including a person's physical conditioning, nutrition and lifestyle, and their genetics.  However, when complications like pain, swelling, stiffness and limited range of motion seem to be blocking a healthy recovery from surgery, keep acupuncture in mind.  It can put you back on the road to healing and help you return to whatever trails of adventure that you like to follow.

Rick DeTroye L.Ac. offers Acupuncture in Northeast Portland, OR

Roots & Branches Revisited

by Rick DeTroye, LAc, MAcOM

Roots & Branches Revisited, Rick DeTroye L.Ac. LLC in Northeast Portland, ORA few years ago, I put together a couple of newsletters and sent them out to clients, friends and business contacts with the intention of introducing people to my practice and to Chinese medicine.  I titled the newsletter, Roots & Branches, in reference to the Chinese medical concepts of ben and biao, AKA,  root and branch.  I'd hoped that it might offer me an opportunity to share information about acupuncture and Chinese herbal medicine with its readers, so that they might get a better understanding of what these practices could offer them. 

Well, somewhere between laziness and paving the road to hell, my good intentions evaporated and I gave up on the newsletter idea.  It was much more work than I'd anticipated and, although I received a lot of positive feedback about what I wrote, my inner writer was effectively squelched.

Since the demise of Roots & Branches, I've often caught myself daydreaming about articles I'd write if I were still publishing it.  I've been practicing acupuncture and Chinese medicine for 15 years, since August of 1998.  During that time, I've worked in a variety of settings and treated people with a wide range of illnesses and conditions.  I've studied with some great teachers who have broadened my understanding of Chinese medicine, what it can treat and who it might benefit.  I've also worked with some terrific patients who, more than anyone, have taught me about how the body works, how the spirit and emotions contribute to healing and what it means to be an acupuncturist.  I believe that things emerge when they need to, when the energy is "ripe".  As my old friend and mentor, Ray, used to say, "It's all about the timing."  It seems that it's time to start writing again, to share some of my thoughts on acupuncture and Chinese medicine, as well as insights from other sources, in the hope that they may help folks in their journeys of healing.  And just to reassure you, MOST of us are on journeys of healing of one sort or another.