Why is it so painful?

Recently on my ortho inpatients placement I had the opportunity to watch orthopaedic surgery. The surgery I saw was a revision of a total knee replacement, which means that they’ve already had a TKR and it has become infected so the surgeon has to take out the metal work, clean it up and put it back in with cement that is packed full of antibiotics.
I was honestly very nervous, I generally avoid anything that looks a bit gross on those medical shows, especially surgery, but I found that once the surgery had started I didn’t feel like I was going to faint at all, I was just absolutely fascinated at what was happening, learning anatomy on cadavers was good, but it’s nothing in comparison to the real living picture. However, what I had been warned about and astounded me the most was the shear force that the surgeons use, drilling and hammering into the bone. What else was interesting was that the patient has full passive range of movement at the end of the surgery, which is very different to how they present when we see them.

There were two main things I will take from this experience, one of which is a greater understanding and empathy for the patient’s pain. The surgery they’ve had is very traumatic, not only does it affect the bone but all the surrounding soft tissues as well. It’s still very important for the patient to move that joint, despite the pain, for the healing purpose, but I think having sympathy for the patient’s pain is very useful in building a report with the patient and increasing patient compliance. The other useful thing that I have gained from my surgery experience is the knowledge that after surgery there is actually nothing wrong with the knee, which is something I’ve found a lot of patient’s fear, because we automatically relate pain to problem which breeds fear, resulting in more pain. This brought home to me the importance of re-assuring the patient that the knee is ok, it’s just been through a very traumatic surgery and is healing. This re-assuring is something that my supervisor had pointed out to me as being very important, but like most things until you see it for yourself it doesn’t sink in.

In saying this it is still obviously important to question the patient about their pain and to take further action if you suspect something is wrong, but in my experience more often than not the pain decreases once the initial anxiety is eased, physio’s hold a primary role in the treatment of patients following orthopaedic surgery and it’s important for us to not just treat the knee but as they tell us at uni, to treat the whole patient. In my opinion, if you ever get offered the chance to view any kind of surgery, even if you’re a bit squeamish like me, jump at the opportunity, it will give you a great insight into the experience of the patient.