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[TKR] ROM of 85 degrees 10 months after TKR

Discussion in 'Knee Replacement Recovery Area' started by HorseGal, Jun 8, 2012.

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  1. HorseGal

    HorseGal New Member

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    I am now 10 months out after my Bilateral TKR. Approx 1month after surgery with PT, I had 98- 100 degrees bend on both knees. Now, at best, I have 85 degrees.

    I have been active, walking is no problem, I have great balance and a good straight leg. But I have great difficulty in getting in and out of a car, walking up and down stairs and getting off any chair, I must use the arm holds to push up on. I have been continually trying to ride a stationary bike and cannot get over the top 4 inch arch with the pedals. The worst thing is I cannot get into my show carriage (pictured), even with a 3-step mounting block. My left knee is far worse...it has a larger replacement in it, but I have difficulties with both knees.

    August 17th is my 1 year aniversary date and I will be seeing my doctor then. What can I ask him for? I am quite disappointed in my results. Any suggestions are appreciated!
     
  2. RestAssured

    RestAssured Forum Advisor

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    Hello,

    I am sorry that you are having problems! When you say 85 degrees ROM I wonder about a couple of things. Did they suggest heel slides on your bed and if you have done them do you feel a resistance at 85 that won't let you go any farther?

    I will tag Jo as she is our forum expert on the nursing end and she might have some answers for you! @Josephine:

    God bless you and I hope you get answers you need for peace of mind when you see your surgeon. He knows your knee and situation better than anyone here.:biggrin:
     
  3. maryo52

    maryo52 Sr Bonesmartie

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    Oh my how discouraging. Well your doctor owes you a workup to ascertain the reason. Did you develop scar tissue? Or did he put the knee in too tight? The fact your flexion went backward suggests scar tissue formation.

    Even my doctor says doctors are defensive and if your doctor is not helpful, you may opt to go seek another opinion. This would be a good plan B.

    If you have scar tissue, you can have that removed arthroscopically. If he put the knee in too tight that's a tricky matter.

    One question is, what was your pre-op flexion?
     
  4. HorseGal

    HorseGal New Member

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    My pre-op ROM was well over 110 degrees, but with pain. I was bone-on-bone. During my out patient therapy at a rehab place, I develped lesions under my incisions. With work and massage, we got that under control, but I often wondered if scar tissue developed on the top of the knee, what would prevent it from developing in the back of the knee.

    When I asked my doctor about the issue at my 3-4 month mark, he said everything is a compromise. Do I have pain when I walk? I don't. But I have great stiffness and no bend!
     
  5. maryo52

    maryo52 Sr Bonesmartie

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    Your doctor sounds very philosophical. But some of us believe they're being paid the big bucks to respond to questions with specific answers. We deserve answers. I find the tricky part is me asking the right questions at the right time.

    The stiffness problem may be resolvable. Many on this forum have gotten their problem addressed as a result of going to another ortho when they seemed to be at a dead end. Or even more than one other ortho.

    I remember when my bend was 85. I was not a happy person. I have long legs and everything was difficult. This is not a minor problem.

    I'll try to tag skigirl. She's another on this forum that's had scar tissue problems although not the limited ROM.
     
  6. skigirl

    skigirl Moderator

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    OMG, I just lost a post!! Oh well.

    I had surgical removal of scar tissue which had covered my knee cap so that it could not move. This caused incredible pain when I rode my bike. My doc does an open procedure and I have had a very slow recovery. For the first three weeks, there was no pt. Then pt began very slowly. After six weeks, I got on the elliptical machine for the first time for FIVE minutes!! Otherwise I have been doing the bike for 20 mins and then doing quad sets and leg lifts. My doc feels that when the knee is hot and swollen, it should not be pushed or scar tissue will form.

    but, for you, I think you will have to go to your doc and try to find an answer for your condition. Is the prosthesis too large? Is the poly spacer too thick? or is there extensive scar tissue?

    I think when he told you the Life is about compromise, that was a cop out. you do not have to accept a leg in this condition. but, you may have to search for a specialist in revision surgery. I know that Sonja has gone to Gerhard Maale in Fort Worth and that the Steadman clinic in Vail, Co has a doc--Dr. Noyes who specializes in Adhesions.

    Since you live in Racine, I think you can find someone nearby. Jamie can help you find a doc-- Jamie

    She has many resources. I think that most of you you should realize that there is help for you out there. I know that Mary O has a rom of 115 after her surgery and she is much more comfortable. I think you can look forward to help as well, but it is better to look for someone who has a lot of experience dealing with these issues.

    Take heart! Kelly
     
  7. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    Sounds like first off you need an MUA. I am surprised that your surgeon would be so laise faire about it. This is no small issue.
     
  8. HorseGal

    HorseGal New Member

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    Thanks for all your advice. I am a very active person and actually got on my horse this weekend with the help of my friends, but could not ride. I could not stand the pain in my left knee when I had my foot in the stirrup. I did have some pain in my right knee too, but not nearly as bad as in my left. I am calling my doctor and get some answers.

    I will keep you all aprised.
     
  9. BJ Mac

    BJ Mac Sr Bonesmartie

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    Hi, I am sorry to hear that you cannot ride your horse or get into your show carriage. That must be awful. I am sure that this long after surgery you were convinced that you would be back to doing these things. I hope that you are able to get something done to help you to gain the range of motion and comfort to get back to doing the things that you love to do. Let us know how it goes. :console:
     
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  10. maryo52

    maryo52 Sr Bonesmartie

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    Horsegal, let us know what comes of your question to your ortho. But I'm a little skeptical because he should've addressed this by now assuming he knew about it. Just know that if you don't get satisfaction with your ortho, there is one who gladly will. Be warned, many revision orthos need you to be one year post-TKR for them to schedule you. Fortunately that's soon, isn't it? I'm not suggesting you need a revision, only that very often it's the doctors who specialize in post-TKR problems who you'd probably see.
     
  11. PhoenixS

    PhoenixS Forum Advisor

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    What a bummer of a story.
    I agree that your OS's answer was inappropriate. He shouldn't be so flip. this is a serious issue.
    I think that you deserve to have a thorough workup, then as Jo suggested, possibly an MUA or LOA (lysis of adhesions) like Kelly had.

    There is something in your knees that is not allowing you to bend them.
    I'd definately see another OS who specializes in revisions. Jamie can hook you up.

    I feel so bad for you. You shouldn't have had to wait a year to get some answers.
    Keep us updated on what the next plan is.
    Sandy
     
  12. HorseGal

    HorseGal New Member

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    Well, I saw my OS yesterday. He tried the "you can walk OK, can't you?" line on me and I would not let it go. Finally, after breaking into uncontrollable tears, me is going to do a manipulation under anesthetic. He said it's a little late for it, but I should be able to get 10-15 degrees more ROM from it. I sure hope so....I understand it is a post-painful endeavor. I just didn't think this would happen with all the work I put into the rehab work after my BTKR. I am not looing forward to the painful recovery....again!

    If anyone has any suggestions as to getting through this manipulation, I would certainly appreciate the information. I need all the direction I can get.
     
  13. skigirl

    skigirl Moderator

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    I don't think that a MUA is horribly painful and I think that the extra rom will be well worth whatever pain there is. You will feel so much better that you can move the knee.

    Be sure not to let a pt crank on that newly mobile knee. Do not go to pain. You want to keep what you got, but not to the point of inflicting pain onto you.
     
  14. Jamie

    Jamie Administrator

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    Well, I can say we have had BoneSmarties who have had successful manipulations up to a year or more after surgery. So I don't agree that's it's "too late."
     
  15. HorseGal

    HorseGal New Member

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    Well fellow Bone Smarties, tomorrow is my big day for a MUA! I sure hope this works. I have the bike at home all set up, my ice machines ready and all my PT is scheduled. Wish me luck. I will keep you posted.

    HG

    P.S. I learned a whole new method for getting your way with men (no offence guys) Cry Like a BABY! It worked!
     
  16. bottomshollow

    bottomshollow Moderator

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    clap.gif Good news HG. Definitely wishing you all the luck in the world. Please do keep us posted. We care.
     
  17. skigirl

    skigirl Moderator

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    Yes, I am very direct and used to be more confrontative when I wanted something. My Gram took me aside and told me that you catch more flies with honey than vinegar!! But, I think tears are the ultimate weapon. Kelly
     
  18. kneeper

    kneeper Forum Advisor

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    fingers crossed for you, HorseGal.
     
  19. RunA42K

    RunA42K Forum Advisor

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    Just read through your thread HorseGal. I sure hope that your MUA goes well and you get the ROM that you need. I am surprised that your OS was just blowing off your lack of ROM by saying you can walk and have no pain! When I went for my 2 weeks post op check up, my OS told me I should be at 90 degrees, I was only 72, I went back in 2 weeks which was one month post op and had 88. I was slow to start but got to 137 after 7 1/2 months. If this MUA does not do the trick I would find a new OS.

    The best of luck to you!
     
  20. maryo52

    maryo52 Sr Bonesmartie

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    Horsegal, well at least something is being done. Just be aware that there are other avenues to address stiffness/scar tissue. Closed arthrolysis, which I had, has a good success rate. Just stick that in the back of your mind as Plan B.
     
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