Why the second total hip/ knee replacement more problematic than the first?
Tommy Conway - Chartered Physiotherapist and Director - OneHEALTH
Recently I had two new clients in my clinic, the first was after getting his second knee replacement. He had the right knee replaced in 2016 and the left knee replaced in January 2021. It was my first time seeing him as the first (right) knee replacement was a huge success and “They never needed physio”. The second (Left) knee replacement was more problematic, he explained how he had followed the same plan but with not the same recovery, the knee replacement was stiffer and more painful, as he explained “ It just didn't feel right”. The second new client was 5 months post operation with a right hip replacement, she had her left hip replaced over 10 years ago. She had a similar story, left hip replacement was a huge success,“I did one or two exercises for 3 months and the hip was perfect”,but again the same story as the first client when it came to the second hip replacement, the movement was worse, the pain was worse and they felt “the leg was dead”. Two different clients, two different joints but the same story, It sometimes isn’t easier on the second go!
After encountering these clients one after the other, I felt it was time to write an article on what I have been noticing for years. If you replace the joint you will have a new hip or knee but it doesn’t stop the body pushing/ turning/ rotating you into the same direction that caused that joint to deteriorate. We have to start thinking about why this joint is a problem? Did you ever stop and think about why the joint is getting damaged or even how it got damaged? Sometimes it can be in one traumatic incident but sometimes it can be like water dripping on a ceiling, it’s no big deal to start with but over a few years it leaves a big stain. What is causing the drip? What is causing the damage? These are the questions people don’t ask. We all want to think, ok it’s damaged, let’s get it fixed but that doesn’t stop the cause, it doesn’t stop the drip.
If you want to cause lasting damage to a joint it has to be done in a rotational/ twisting manner. Think about how screws and drills work, they rotate to cause the lasting effect. The same thing happens with your hip and knee joints. It is the rotation of one bone against the other that causes the lasting damage. The first client I talked about was overloading the right knee for years. In my initial assessment, I could see he put all his weight through his right leg and knee, he was good at turning to the right and inturn turning/ twisting into his right knee. So by replacing the right knee, it just gave him a knee joint to constantly drill away at for the next 10 -20 years. The problem occurred for him when he changed the other knee, the left knee was doing a very different job to the right. Think about the left knee as his stilt, it had a very different role to the right. It didn’t bear weight and was good at directing pressure onto the right leg, it was good at turning/ twisting away from the left knee. In order to do that the left knee needs to be able to turn right. The problems started when this client got the knee replaced, the left knee now no longer had the ability to turn right, that’s why it didn’t get the same response, the surgery changed its job.
Both of these clients will be successful with their rehabilitation, I have no doubt but the moral of the story is, you need to think about what is causing the drip, screwing, drilling of your joint and that sometimes needs to be corrected before you start the screwing, drilling that has to go on to replace the next joint!