Dan,

I agree with you and Jenna, it would be an EXCELLENT location to needle for this patient, and likely very productive for symptom modification. To answer all aspects of your question—

when in doubt, it’s always best to ask the surgeon you work with what boundaries he has regarding dry needling if any (more specifically in regards to intra-articular needle points vs. surrounding/supporting structures) .

*Most of the time* I have heard somewhere between 6 weeks-3 months is the response of most surgeons when it comes to needling into the joint space that was operated on (some very strict ones may even say never).

In this case of a TKR, the common fibular needle point would not go into the joint space itself, so the surgeon may be even more lenient on time frame for locations like this or even other supporting structures like the quadriceps, hamstrings, gastroc etc. In terms of healing and patient safety, 6 weeks is plenty long enough wait time. I have needled surrounding structures like this far earlier post operatively (with the green light from surgeons).

Again, it’s always best to have open communication with surgeons to get their opinions on what they are comfortable with, especially if you hope to maintain a good relationship with them. I have worked with a variety of different surgeons who have had varying degrees of strictness regarding the post-operative phases.  

hope this helps!

Nina

Thank you all for the insight!

remember post total knee or hip there is a major concern for bacterial infection so post surgical joints have a greater "fear" from surgeons as bacteria that gets to the joint requires complete removal of hardware- long antibiotic treatment then replanting of hardware.  This is not such a big issue with general type surgeries so discussion with the surgeons is warranted.  Most have a 6 week limit on DN but some don't want it at all.  Remember patients have to take antibiotics before even dental procedures going forward, some surgeons say for life, so do I think DN causes any of that.... no but the fear of bacterial infections in these cases is a major concern.