TKR Doc / PT says keep working

Staythecourseor

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Hello All,

I'm 8 weeks into R-Knee Replacement (2/22) and had MUA this week. Overall the surgery itself was not too bad and early on I thought I was in good shape but lack of extension and flexion led to MUA. I'm a 54 year old guy that's not overly flexible but have not returned to pre-surgery ROM and was hoping to actually pick up some movement. Pre-surgery things like stairs and walking were normal but I haven't been able to achieve my normal gait yet. I can tolerate the PT but always sore and sometimes swollen - ice and Ibuprofen help some.

My question is do I continue on the same course of PT and CPM Machine for the next 4-5 weeks or dial back some or ? Any thoughts/advice welcome. Thank you and good luck to all.
 
Hi Stay the Course,
I'm brand new so I have no idea about the answers to your questions. I have found my PT to be an angel and I will do whatever she asks. We have started slowly. There are administrators who can provide information. From my simplistic perspective, keep moving but don't push too hard.

I just wanted to send a hug and wish you an easy recovery.
 
Hello @Staythecourseor
Welcome to BoneSmart and recovery! Thanks for joining us. Please share the exact date of your February surgery below. Thank you in advance. :)

At only eight weeks post op, you may need to lower your expectations. I mention that because you’re very early into a recovery that can take a full year and even longer for some. Members have noticed progress into their second and even third years post-op.

While I haven’t had a knee replaced, it sounds as though you’re engaging in some rather aggressive and unnecessary PT. You mention you can “tolerate” the PT which sounds like you may be pushing yourself through, with the end result being pain and swelling that OTC meds aren’t completely effective in eliminating. I believe the aggressive PT is causing an inflammatory response which adversely affects the soft tissue surrounding your knee then decreasing your range of motion. I’d suggest you back off the PT and allow that knee to heal without constantly irritating it.

I will leave our Recovery Guidelines with wishes for your comfort and relief from pain. I’m sure others will stop by to comment. Please continue to stick with us and share your progress. You’ll find great support and encouragement here.

Knee Recovery: The Guidelines

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.


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
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital


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 a 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 history before providing advice.
 
Hi and Welcome!

Please also give us the date of the MUA and we’ll add that to your signature.

Some PTs give us exercises that are inappropriate for a knee replacement. While we expect them to know what’s best for us, sadly, some don’t.

Take a break and give your knee a rest, so it can heal without being upset by each PT session. Gentle bends and short walks, and no other formal exercises can do wonders.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
 
@Staythecourseor Welcome to BoneSmart! Please remember that from the date of your MUA you reset the clock on your recovery. Although your knee may settle more quickly than after your original TKR, it is very traumatised and will need rest, ice and elevation to settle.

Please don't worry about ROM right now. That knee just needs time and patience.
 
I've seen some improvement in flexion (I think partially related to use of CPM machine). I'm still having trouble with extension. I have some pain/discomfort on the inside of the knee I didn't have before the MUA.
 
Extension can take a while longer than flex, and an MUA doesn’t usually address the extension. You are still early in recovery, it will improve in time. Walking will gently help it. Some members try taking a longer stride when walking, to give the back of your leg a bit more of a gentle stretch. I wasn‘t able to manage that, but it worked well for @sistersinhim .
 
Jockette is correct. My extension was slower coming in so I googled tor a natural way to decrease the bend in the straight knee. What worked well for me was to increase my stride with a heel to toe contact. I made sure that I either used my walker or had something close I could hold on to. Walking with this long, abnormal stride will likely throw you off balance so be careful. My extension didn't come in overnight, of course, but it did improve slowly. Now, it is 0!
 
Hello All,

I'm now 11 months post R-Knee replacement (Feb 22) and 9 month post MUA (Apr 22). My extension is good but my flexibility is still lacking. With that I mean I'm not back to pre-surgery range. Doc thinks it's the IT band and says to keep working (riding the bike and stretching). I have been diligently exercising (walking, biking, etc...) since release from PT in Jun 22.

Looking for any input/advice. My concern is could there be additional scar tissue holding me back...? Thanks.

Dan
 
I see that your extension finally improved. At 9 months out from your MUA your knee probably still has some lingering swelling inside and out. Have you tried icing and elevating more? That could help your body drain the fluid from your knee and allow that bend to improve.
 

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