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Recovery in Orthopaedic Surgery

Orthopaedic structures, whether bone, ligament, tendon or cartilage, repair themselves much more slowly than other tissues.  This is because these mechanical and load accepting structures are dense with relatively poor blood supply and have a substantial deposition of “matrix”.

 

While the skin, particularly of the face or the hand, heal within days or weeks these other structures do not. This perplexes many patients because they expect the rate of healing of “orthopaedic structures” to be similar to that of well vascularised soft tissue. This incorrect perspective produces much irritation and frustration in many patients.  At times the soft tissue overlying a structural component adds to the misapprehension.  The skin may heal rapidly, but the underlying structures may take not days but weeks, months or years to fully recover whereas the recovery of the skin might lead to a mis-perception that this healing supposes similar rapid healing of deeper structures.

 

A disconcerting aspect of recovery from “orthopaedic” injuries (including surgery which takes a similar pattern) is the apparent relapse often experienced.  Frequently patients will say “I was getting so much better and doing much more and now look, I am right back to where I was weeks ago”.  Even some orthopaedic surgeons are disturbed by this, and often prompted into further investigations, believing that there has been a “complication”.

 

However, this uneven rate of recovery is perfectly usual.  The misconception is that recovery is expected to be linear with incremental improvement.  Said another way it is expected that the symptoms on Wednesday will be less than those on Tuesday, and those on Thursday less than on Wednesday: but this is not the way it works.

 

The reason is that as recovery of structural tissues occur the patient will use the body more. This is perfectly natural and understandable.  However, it is by using the body more that additional strain is placed on the healing structures and the symptoms worsen.

 

Thus, orthopaedic injury and surgery is never followed by a straight line recovery graph.  It will be “two steps forward one step back” and then another one or two steps forward again.  This is a “saw- tooth” graph of recovery and is expected.

 

There are some exceptions, particularly with joint “replacement’.  It is worth again emphasizing that joints are never surgically “replaced”.  They are substituted.  An artificial joint implanted into the body will never have the full functional capacities of the natural joint.  Therefore it should not be assumed that all and every activity possible with the natural joint will be duplicated in the artificial joint.  Considerable modification of lifestyle may be necessary in many instances.

 

Taking that view, full and total recovery never occurs with joint substitution.  On the other hand, relatively rapid recovery in the first days and weeks is not unusual.  Persons with lower limb joint replacements are often walking the day after surgery. They will then believe that their return to “normality” will be spectacular.  However, it must be born in mind that an arthritic joint will, often, have been present for a considerable time before it is treated surgically.  During that time, particularly when there has been pain in the joint, many of the muscles will have weaken and at times shorten.

 

Therefore the recovery is not simply that time that taken to repair the surgical incisions but a retraining of the muscles and other moving parts.  This can take many weeks or months.  “Training” in a less demanding context, such as in a swimming pool, considerably reduces the gravitational (weight) loading on supportive structures, and so assists eventual healing.

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