TKR Weakness after Knee Replacement

coffeegirl

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A family member had a total left knee replacement on June 26. She has been told by her PT that her ROM is acceptable (107° at 16 days post-op) but she is still very weak and using the walker, requiring a lot of help with daily activities. Her PT is disappointed and says only extremely elderly patients are still using the walker at this point. She was previously very active. 12,000 steps was a light day prior to surgery and she did PT prior to surgery to strengthen. However, earlier this year, she had a very serious infection and was hospitalized for 3 days. She and I both feel that it was likely the infection that weakened her. However, the PT seemed to indicate that she is much farther behind than most. Has anyone else been still using the walker at 2.5 weeks and recovered well? Additionally, I go back to work Tuesday and appreciate any tips for ways she/I can prepare for her being alone most of the day at the weakened state. Thank you in advance.
 
I used a walker for 2 weeks after my first PKR. It was recommended to use it up to the 2-week checkup.
(Switched to a cane a week sooner and very cautiously after the second PKR, but that was because I was getting ready to have RCR shoulder surgery.)
 
Hi and Welcome to Bonesmart.

Your friend is coming along just fine. Her flexion part of ROM is excellent for 16 days. (ROM is both flexion and extension). She’s weak because she just had major surgery 16 days ago and there is a huge energy drain on her body that is trying to heal from this surgical onslaught.

That PT has unrealistic expectations and your friend would do very well to find a different PT facility, one with a better attitude, where they will be more encouraging. My guess is this facility is also going to overwork your friend which can cause setbacks and inhibit healing.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this
6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs

Elevation is the key

Ice to control pain and swelling

Heel slides and how to do them properly

Chart representation of TKR recovery

Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 
I would run from that PT clinic if I were her. I am only 46 and was super athletic and fit before my TKR. I still needed the walker for a full 4 wks and didn't even have my PT suggest to get rid of it until the 4 wk mark. I weaned from it over 4-5 days, using it less each day, but only when we were sure my gait didn't suffer and only if I wasn't limping instead. Thus, I still used it a little at 4 wks and 5 days post-op. Heck, I could barely even put weight on it at 16 days post-op. :cry:

I also agree that if a PT is already treating your family member this way, I can only imagine how much more guilt and over-aggressive PT activity will be applied. That's not necessary and actually counterproductive to recovery. It sounds to me like the PT wants a fast, easy patient to make his own job easier.:hissy:
 
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I'm throwing down the penalty flag for that physical therapist! Saying she's behind because she's using a walker at 2.5 weeks is hogwash! The truth is some people use a walker for a few weeks or a little more, some a couple of weeks, and some barely use one at all. Every single person is different, all recoveries are different and all knees are different. Therefore, how long she uses her walker is a personal decision based on how strong and steady she feels.

My OS asked me to use mine for around three weeks, then go to a cane for another few weeks, or as long as I felt I needed it. It wasn't an order, just common sense based on his knowledge of my body and how much work he had done, and knowing how I was recovering. It happened to be at around three weeks that I felt I could lose the walker and go to a cane, and I used a cane in the house for a little longer, but used it when out and about for a bit longer than inside my house, until I felt steady enough to walk safely without it.

If I used a PT after knee surgery (yea-like that would ever happen :nah:) and they told me they were "disappointed" in me, I'd tell them they're supposed to encourage patients, not try to shame them into compliance with their disgraceful comments. Then I'd leave, or kick them out of my house if it was in-home PT, and then I'd call their supervisor and my OS to tell him what they said! Tell your friend to come to this site and get information, if she can or will, and also tell her to use her walker for as long as she needs it, within reason that is. I would suggest she slowly phase out the walker in the coming weeks and go to a cane, at least when she's out and about, if not inside, until she is steady on her feet. She can also ask her OS for his advice on how long she should reasonably expect to use walking aids.
 
Add me to the chorus of those who say the PT is talking through her hat. :hissy:

Your family member is doing fine and sounds like she's "ahead" of where I was. (Not that it's a contest or that everyone hits the same milestones at exactly the same time.) I used a walker for about 3 weeks and my bend didn't hit 90 for around 5 weeks due to swelling.
[And I'm doing fine all these years since, thank you very much. :wink: ] There is no need to rush off the walker. I can tell you my PT looked at how I was walking and I judged how confident I was feeling before I tried the cane. It was a pretty natural progression, not on a schedule.
 
When I saw my surgeon for my post-op appointment 9 days after my partial knee replacement, he didn't like that I was "still" using a walker, either. And the last time I was in shape was the Ford administration, and I am also in my 70s. (Perhaps that qualifies as extremely elderly in that PT's book!)

I "only" had a partial knee replacement and used a walker for 2 full weeks. And the only reason I didn't continue to use one was that at 2 weeks, I left the rehab facility I had been staying in, and I found out on checkout day that Medicare wouldn't pay for a walker for reasons that will bore you.

It turned out fine; I didn't need the walker after all. But I imagine if I'd had a TKR, I would have been in big trouble.
 
Thank you all! We feel much better after reading all of your comments. This was the homecare therapist and she will be seeing an outside therapist by the end of the week. (One that has seen both of us in the past and that we trust completely). It is good to hear that others had a "slow" recovery too and have turned out just fine! Also @lovetocookandsew, your comment about shape made her laugh and nod her head.
 
Oh my, the Ford administration. I needed that belly laugh.

And for the record I'm at 4 months, 3rd revision and still using a walker, mostly. Occasionally I use a cane.
 

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