TKR ‘Hard’ knee

[mendogal]

Walking is the best!
My understanding of recent research is that we seniors have to have protein as a higher percentage of our diet in order to rebuild muscle, and it needs to be spread among our meals rather than a big protein load at dinner. Since my first knee replacement in January I've been eating a variety - often a savory breakfast with whole grains, plant proteins, and nuts; lunch of nonfat Greek yogurt with fruit and nuts (or leftover yesterday's dinner), and some combo of eggs, meat, and plant proteins at dinner.
Now that I have more stamina, and my newer June knee can handle the exercise bike at the gym (no resistance, just for range of motion) I have also resumed upper body weight training.

 

[Layla]

Happy Three Month Anniversary!
I hope you've had a good month. Please let us know how your recovery is going.
We'd love to hear from you. All the best!
@Ravendancer

 

[Ravendancer]

Thank you. Almost like birthday wishes, I have read on this website not to be concerned with flexion, that it will come in time. I'm only at 112 at 3 months. Both the physio and the surgeon have suggested (indirectly) that it's not as good as it should be. I've been given more flexion exercises with the hopes that it will improve. My knee is still swollen and it's quite painful to push past that. I am concerned that I won't get full mobility back so I have been pushing it a little past my pain threshold, wondering if it's a good thing to do. I am assuming that I can't go beyond 112 comfortably because my knee is still healing and because of the swelling. I am walking fine and can go upstairs and ride my stationary bike with the seat in the lowest position. And I can see an improvement over the last month with my flexibility.
I just don't understand, why we're told about this 3-month brick wall, if indeed, we can still improve many months after that.

 

[mendogal]

I'm sorry they are setting unrealistic expectations when your instincts are sound: It is indeed the swelling that's limiting your flexion. Pushing past the comfort level into pain can't increase your flexion or extension.

Meanwhile, your description of your functional status is GREAT! You might consider trying what worked for me: I reached a point where I didn't let anyone measure my flexion or extension, didn't let anybody stretch or push me, and instead just kept written notes of every single little milestone in functional status. How does the old song go? "Accentuate the positive!"

 

[Jockette]

I'm only at 112 at 3 months. Both the physio and the surgeon have suggested (indirectly) that it's not as good as it should be.

112 at 3 months is great! And, where you are now is not where you will end up. We all heal at different rates, which means we regain our ROM on our own time frame, not someone else‘s time frame.

My ROM continued to improve all through my second year, and a bit more in my third year!

I've been given more flexion exercises with the hopes that it will improve.

You don’t need more exercises, what you need is time!

Regaining our ROM does not require forceful bending or painful exercises. That is counterproductive.

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.

 

[sistersinhim]

My knee is still swollen and it's quite painful to push past that.

Pushing to pain is only making your knee more swollen.

I am assuming that I can't go beyond 112 comfortably because my knee is still healing and because of the swelling.

You've got it! Stop all your extra exercises and just don't worry about it. Your normal daily activities are all your knee needs to lose that swelling and increase your bend. Remember, a swollen knee does not bend well.

 

[Ravendancer]

I’ve past a milestone a few days ago (6 weeks post op RTKR) as I’ve managed to do a complete circle on my stationary bike (seat a highest position), even though it still hurts, but it’s bearable. I’m also walking about 20-30 minutes a day. I’m thinking of buying a mini stair stepper with the resistance bands attached. This exercise seems to be low impact so I’m thinking this would be a good exercise for getting the knees (and legs) into shape.
Any thoughts or advice on this ?

 

[Jockette]

I’m thinking of buying a mini stair stepper with the resistance bands attached.

I think you should heal another couple of months or more before using something like this. 6 weeks is very early in this year long recovery. The walking you are doing is more than plenty for your stage of recovery. Doing more exercise does not equal faster healing, and if done too soon, can cause a setback.

This exercise seems to be low impact so I’m thinking this would be a good exercise for getting the knees (and legs) into shape.

This might be low impact before your surgery, but you are not in training at this point, you are recovering/healing from major surgery. Patience is important during this early time of healing.

 

[EalingGran]

Agree with @Jockette that stair stepping and resistance bands is too tough for 6 weeks out. Walking and gentle stretching is plenty for this stage.
I gradually introduced some pilates and glute/quad work but didn't use any bands or weights until about 5 months.
Stairs were the last to come comfortably for me at more like 7-8 months but I had a lot of stairs at home anyway.

 

[Ravendancer]

Actually I should have been a bit clearer regarding the stair stepper. I had thought the same thing, that it was much too early to do this exercise. I was thinking about doing this exercise in about 3 months. I’m certainly not into heavy duty training, I’m just considering options for when I’m more healed. Being as muscle mass (sarcopenia) is harder to maintain as we age, this seemed like a good option. I just wasn’t certain if it was safe for people who have had TKR.

 

[mendogal]

I agree with deferring it.

One problem is that it's a full weightbearing totally repetitive movement within a very narrow range of motion. That makes it incredibly easy to overdo it on isolated muscles or tendons without realizing it.

My other concern - and I had to look this up - the models using resistance bands on them have terrible "body mechanics" (I prefer the term "structure.") And given the way it's set up it looks like it would be very easy, unless going at a snail's pace in front of a full length mirror, to develop skewing or imbalances that become ingrained.

Before buying one, when your body is ready for it you might Iook into something similar at a gym and try it.

I say this as someone who loves slow focused strength training. I didn't use ankle weights until after six months - and very light ones! With my younger knee at 8 months out, I'm just now considering getting back onto resistance machines, initially with my PT.

 

[Ravendancer]

Thank you very much for your insights. I will definitely keep this all in mind.

I did notice that the demonstration using the resistance bands looked awkward and not quite right. I had considered that the body looked a bit askew and not structurally safe.

I will talk to my doctor and my PT and see what their thoughts are on this also. Although at this point I’m in no rush to purchase anything. I have my stationary bike for exercise, and walking, which I think it probably most appropriate now.

 

[benne68]

Happy 2-month an-knee-versary, @Ravendancer! It sounds like recovery #2 is going well.

I'm just a couple of weeks ahead of you, and I am finding that alternating between spinning on the stationary bike one day, then walking the next day is working well for my recovery.

How is your right knee doing now that it's carrying more of the load?

 

[Ravendancer]

Thank you Benne! I have been cycling everyday 2 or 3 X’s day for 5 minutes at a time. And I also try to walk everyday for at least 20 minutes. Hopefully I’m not overdoing it as I‘m still doing physio workouts 2-3 times a day for about 10 mins.
But I do spend time bonding with the couch .

My right knee is doing find, although I still have a lump on the outside of my knee which is still noticeable (a little painful) when I walk. Also because my left knee is surgically further behind my right, I can’t cycle as long on my stationary bike. My surgery’s were 4 1/2 months apart.

But I’m plugging away, trying to exercise both legs without overdoing it.

 

[Layla]

Happy Two Month Anniversary!
Slow and steady will get you there. You're doing great!
Keep up the good work, stay in touch and have a wonderful week.
@Ravendancer

 

[Ravendancer]

Thank you….

 

[Ravendancer]

At this point, I'm almost 3 months post-op with my left knee (TKR). Right knee now 7 months. I did weaken and buy a stair stepper, which I really like. As I was unsure exactly how often I should use it, I spoke to my PT and osteosurgeon about it and they both didn't think it would be a problem. My PT says 5-10 mins a day once a day.
I'm only doing about 2 minutes a day a couple of times a day, just to see how it feels. So far so good.
I'm thinking now that I'm further along in recovery that this is ok to do. Before (at 6 weeks) I was advised it was too early after the TKR.
Just wondering if anyone has had experience with a stair stepper after TKR and may have any advice.

thank you

 

[mendogal]

At this point it's not too early however it will be very easy to overdo things. A few tips
- don't quickly step up and down as if this is aerobics! Each separate step should be slow and controlled, allowing the flexors and extensors to coordinate with each other and for you to focus on weight transfers
- good structure means not staring at your feet. Aim your heart at the horizon and if you need a hand support for balance set up where you can access a surface
- increase your time in small increments. If 2 minutes is good, try 3 minutes rather than 5 minutes.

 

[Ravendancer]

Thank you, good advice. I'm certainly going slow and have myself positioned in front of a table just in case I lose my balance. It feels like a worthwhile exercise and I will take it slowly.

 

[Layla]

Happy Three Month Anniversary!
I hope you're doing well. Enjoy the rest of the week and have a great Easter weekend if you celebrate.
@Ravendancer