TKR An Outdoor Lover's Recovery

[Jockette]

A cane or hiking poles, whatever you like better, might help the limp. You probably don’t need anything at home, I did find using it in the house was a hassle, I never knew what to do with it when I needed 2 hand for something! I preferred my walker, it stood up all by itself when I didn’t need it!

I used my cane for quite a while, when I wasn’t home, as I had a lot of trouble regaining my balance. (I never had balance issues before surgery) It was probably three or four months when one of my good friends asked me when I was going to get rid of it. I admit I fell to peer pressure and stopped using it, and I did ok, so maybe I was more ready than I thought. It just made me feel very secure. If I have to do this again, I’m going to buy a pretty one, and then if I don’t want to give it up, I can just say it’s because it‘s too pretty!

 

[Kneeophyte]

Thanks for the comments.. I'll keep those in mind when it's again my turn to take on grocery shopping or when I need to be in a place where there could be a lot of people close together.

Between COVID19 protocols & WFH, it seems like there are things about recovery that are easier than they would be otherwise.

 

[Sisterpat]

Yep, agree! I shed the walker and used a cane for a couple of weeks. Helped a lot with stability.

 

[Kneeophyte]

Friends in TKR recovery: This is a plug for swimming. If you have safe & available pool access during these Covid19 times & you have even the smallest interest in swimming, give it a try. Start slow & see how your knee reacts....

Right now I can't yet walk or bike nearly enough to get a reasonable amount of exercise. But I CAN swim. That's done wonders for my morale, along with helping with knee rehab & regaining some of the fitness lost post-TKR.

 

[sistersinhim]

Those of you who want to start swimming, start very slowly. At four months I went back and overdid it very badly. It was just two laps, but it set me back for a few weeks with added pain and swelling. I waited another month and tried it again, just one lap this time, and did fine. After slowly increasing my laps, I got back up to normal. Water adds resistance, which is like using weights on your knee so it doesn't take much to anger it.

 

[Kneeophyte]

I'm at 2 1/2 months post-surgery today. Today I received an email from the surgeon's office noting that I was "just over the half-way point of the major healing phase for your knee replacement."

So I guess he's saying that he considers "the major healing phase" to take 5 months.....

This surgeon does a huge number of TKRs each year & is considered a leader in the field. But I sure am getting the idea that there's likely a heck of a lot of healing that will still be taking place well after the 5-month mark.

 

[Jockette]

Maybe the word “major” healing is the operative word.

Yes indeed, there will still be lots of healing after the 5 month mark! I continued to heal and improve well into my second year, and even some more in my third.

 

[FCBayern]

Maybe the word “major” healing is the operative word.

I think Jockette is right, the worst of my knee recovery was over by 5 months but the healing improvements continue into my third year since TKR.

 

[Kneeophyte]

Yes, I noticed the phrase "major healing phase" is totally vague, while declaring the half-way point to be at 2 1/2 months makes the claim sound very quantitative.

When I was deciding where to have the surgery done, it was obvious this particular surgeon & his staff were extremely good at self-promotion & at running a slick operation. In the end I decided that the surgical results were the most important thing to me & that this group was probably about as good as it gets, despite those features.

 

[Nana26]

@Kneeophyte I just read your post about the pool and I want to thank you for the encouragement! I am probably going to try it next week for the first time since surgery. I was planning to do a little bit of walking but may try to swim a lap instead. My goal is to get back to my water aerobics class some time this summer.

 

[Kneeophyte]

@Nana26 Wonderful!

As our BoneSmart moderators consistently remind us, take it easy those first times back in the water.

We all have to figure out what works for our own situation, but my experience has been nothing but positive. I may still be stiff-legged & not yet able to walk nearly as far as I'd like (let alone hike), but swimming hasn't troubled my knee at all. It is a joy to have have re-claimed this activity of my pre-surgery life -- more to come I trust!

 

[Kneeophyte]

How long is it important to keep doing exercises that are specifically meant to increase range of motion? My extension was fine and flexion reasonable at the six to eight weeks post-TKR point. Can I just relay on stationary biking, swimming, ADL, & healing from here on out?

The recent email from my surgeon's office (one that told me I was at the halfway point in the "major healing phase"), also said "...the benefits of PT fade away if you don't continue the exercises..."

 

[Jockette]

My opinion is that the specific exercises are not necessary. I stopped them at 4 weeks, and didn’t really do them that often when I wasn’t at PT, anyway. Some people believe otherwise.

The things you mentioned are fine, and even those are a choice. We have members who didn’t do any “exercises“ and just did ADLs, and had excellent results.

This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."
It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)
So, if a OS or PT bullies you into thinking your ROM will not improve over time they are wrong. By the way, I haven't been back to see the OS since that horrible appointment at 6 weeks, but I sure am going back when I reach 120 just to say, "Ha! You were wrong, BoneSmart was right!" “

And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. “

 

[RIT387]

Friends in TKR recovery: This is a plug for swimming. If you have safe & available pool access during these Covid19 times & you have even the smallest interest in swimming, give it a try. Start slow & see how your knee reacts....

Right now I can't yet walk or bike nearly enough to get a reasonable amount of exercise. But I CAN swim. That's done wonders for my morale, along with helping with knee rehab & regaining some of the fitness lost post-TKR.

I'll chime in too to echo this. It has been so good for my mind, body, and spirit to be able to pool water walk and do a few stretching exercises in the water. Then get in the warm jacuzzi afterwards after so much pain and swelling. Very soothing. I'm thankful I live in a community with such amenities. Seek what feels good!

 

[Kneeophyte]

@Jockette, such a puzzling divide between what surgeons (at least apparently many in the US) say about PT & the "window of opportunity" in contrast to the experiences reported here/the BoneSmart recommendations!

Are there studies that some surgeons accept and others reject?

Or are the surgeons who insist on aggressive range-of-motion-focused exercises assuming they need to do that to get their patients motivated to do more than sit on the couch?

Even for those who opt out of rigorous early PT & ongoing exercises, it is worrisome that there is this kind of disagreement. We all want the best possible outcomes from our surgeries....

 

[Jockette]

Well, we shouldn’t sit around and do nothing in our recovery, it’s important to keep the knee mobile, but the list of many exercises is not necessary, and I’ve seen members who do too many exercises, or even worse, inappropriate ones, and all it gets them is constant pain and swelling. I’ve also seen members who did no “formal rehab” and come out fine in the end. So, as @FCBayern is fond of saying, you can do the painful rehab, or the gentle walk through the meadow, (or something like that, he‘ll tell you) to recover just fine.

We have have to find a balance, and a rehab that works for us.

Until I found Bonesmart at 4 weeks post op, all I heard from people was “do your exercises“ and “bend that knee!” At one week post op my PT gently continued to push my knee into excruciating pain, and because I gripped the sides of the table so tightly, I ended up with a new diagnosis of acute tendinitis in my shoulder, and the dilaudud I was taking at the time didn’t touch that new pain.

My PT put me in a pool at 4 weeks for a 50 minute session of countless bending exercises, walking frontwards, sidewards and backwards! That was it for me. It took 3 days to recover from that session, I googled stopping ”therapy” and found Bonesmart, and learned about the common sense of gentle rehab approach, something I’d never heard of before. After that I moved my knee gently and took short walks and did my daily activities.

Feeling guilty and still unsure, sometimes I would be swayed to push my knee into more of a bend than I should have, and every time it set me back. My knee has always been, and still is, very sensitive to anything it doesn’t like, thus the title of my thread, My Drama Queen Patellofemoral Knee.

Exercises and activity are very personal, just be sure the ones you do agree with your particular knee, and don’t increase pain and swelling. For some of us, like me, less is more. My chiropractor calls me her less is more girl, as she can’t do as much with me as she can with other patients.

 

[Jockette]

And, we actually have a few members who’s surgeons tell them to just do their daily activities as their rehab, so there really is a wide variety of opinions about this recovery. That’s why I think it’s ok to decide for ourselves how we will rehab our knee. There isn’t only one way to do it.

 

[FCBayern]

It can be very confusing getting conflicting opinions @Kneeophyte, I completely understand that. Our guiding principle (if I can call it that) is to listen to your own body. If you do something that causes pain or swelling that night or the next day, it was too much for your new joint, and you need to do a little less. Some members do well with all the recommended PT, but there are also many that don't, and even PT's that "force bend" a new joint. In my personal opinion there will be a special place in hell for those individuals. This is my story:

Prior to my TKR I was aware of the BoneSmart gentle approach to recovery as opposed to rigorous PT. I was lucky enough to find the site before my TKR. Even though I knew about the BoneSmart approach my OS was all about PT and "whatever ROM you have when your scar turns silver is all the ROM you will ever have." He was the trained surgeon that has done many, many replacements, he must know what he's talking about right? So off I went to my first visit to PT, about 2 weeks out from TKR. The next day when my knee was more swollen and I was in much more pain I opted for a BoneSmart recovery. I never went to another PT session. That was one of the best decisions of my life. Not only did I suffer less pain, but my ROM has continued to improve over two years. I've been hiking over rough terrain for good distances, scuba diving, and just living a happy active pain free life with more ROM than I ever thought I would have again after many painful years. I've now had a hip replacement with equal success following a BoneSmart approach. You don't have to suffer needlessly to have an amazing recovery.

My thought about PT that Jokette mentioned above is:

It is a long journey but if you stick with the BoneSmart approach the journey will be less painful and you will still reach the same final destination. Ultimately you get to choose the path, the tough rocky road through painful PT, or the BoneSmart path through the meadow with the pretty wild flowers.

 

[sistersinhim]

I was blessed to have a surgeon that never pushed PT. He gave me a prescription for it, which I threw away and never went. When I went for my 3 return checkups, all he wanted was to see what my knee would do. Never one question about PT! Of course, he knew I was a single lady that had to take care of myself, so obviously he trusted that I would not be just laying around all the time.

After 12 knee surgeries, I know that I do not need PT, and neither does anyone else if they do their own daily activities. My knee recovered just fine all on its own with only my daily activities. I didn't have the terrible swelling or agonizing pain that so many have after taking formal PT either. I knew the Bonesmart way worked before Bonesmart was even thought of. My surgeries started in the early 80s and I never went to PT even back then. I just didn't see the need for it. Bonesmart was formed around 2004. By then I had already had 6 knee surgeries and rehabbed the Bonesmart way!

 

[Kneeophyte]

What I continue to wonder about is WHY some surgeons push for aggressive & early exercises to increase range of motion (ROM). You'd expect surgeons to uniformly avoid pushing the limited-window-of-opportunity idea unless there were solid clinical studies showing that the majority of TKR patients have better ROM outcomes that way than if they've followed a more relaxed plan. If there is good evidence the early-ROM-exercise-plan benefits most (even if not all) patients, then it at least makes some kind of sense.

Maybe most patients do fine either way, but they're just trying to prevent less common, but potentially serious issues like adhesions?

I see a big downside to being told it is essential not to miss the window-of-opportunity to regain ROM -- recovery is stress enough without trying to second-guess the advice we're receiving from our medical team.