TKR 12 weeks and Knee-Cation

[cycling67]

Update: Hello to everyone! I wanted to provide a quick update as to my progress and would love to hear any advice.

I am now 14 weeks post surgery from my right total knee replacement. I have had, and still do, challenges with getting flexion back. I am still around the 105 - 108 degree flextion mark, AFTER full warm up and can't get beyond. I saw my ortho surgeon this past Tuesday for a follow-up. I was SO worried and stressed prior to the appointment as I feared he would be disappointed in my progress and maybe even worse, something might be wrong. However, much to my dismay, he said that he was actually pleased with my progress. Of course he would like more but given what he had to do and my knee, he is pleased. Phew!!!!! I thought that some of these reasons he gave for slow flexion return might help others.

1. This was my 7th surgery on this knee therefore likely scar tissue building up and bottom line, it is my 7th surgery. The knee and muscles are just plain tired.

2. The amount of re-alignment from a valgus (knock-kneed) position he did. He moved my knee 8 - 10 degrees in which, as you can imagine, has wreaked havoc on my muscles. This is a huge complaint and frustration of mine ranging from pain in my hip, gluteal area, hamstrings, calf muslces and feet. OW!!!!! My OS said that the muslces are trying to "be OK" in there new spot but it is going to take awhile. I think that the joint might respond faster when these muscles CALM down but this requires patience! I hate that "P" word. LOL

3. Additional work during surgery for alignment and hardware removal from prior tibial osteotomy

4. Finally the size of the knee. My OS used a male gender knee in my knee as the female size would not have covered the entire surface of the bone. Also as I am "younger" he wants this to be a long lasting one. The knee will bend (at least did in surgery) but I will have a harder time getting it there.

While all of these factors provide a reason for my slowness it certainly doesn't take away, completely, the discouragement and frustration at times of not having decent ROM. I would be very pleased with 120 - 125 flexion and am hopeful that I can achieve that but it is going to take more PT and more patience on my part.

I would LOVE to hear from anyone and everyone of ideas, suggestions, etc... for continued ROM at this 14 week post-op stage. I continue with my stationary cycling (many times during the day), small walks and gentle stretching. This is my OS philosphy as well which is SO wonderful to have match my thoughts and this forum's mantra.

Many thanks in advance to replies. I appreciate it! Now I am off to my 2nd cycling session of the day. If only I could stay moving 24x7 then I might not even get stiff again. LOL
All my best to each and every one of you regardless of your stage in recovery!!!

Cycling67 (Brenda)

 

[Josephine]

Well, given all that your surgeon described, I think 105+ IS a good flexion and that more will come in time. Just be P-P-P-P-P-P - - - - nope can't say it! But to put it another way, you'll just have to wait!

small walks and gentle stretching. This is my OS philosophy as well which is SO wonderful to have match my thoughts and this forums's mantra.

That's unique to hear - and wonderful I agree!

 

[Celle]

Thank you, Brenda! That was a very helpful update. All the reasons your surgeon gave you sound logical and understandable - and you are right, it could help other people to understand their slow progress.

I know you hate that patience word - it's the hardest thing to do - but truly, time is on your side here. You do know, don't you, that it's possible to continue to improve ROM for a year or even longer after a TKR?

You're doing the right thing in having a gentle approach to exercise and your knee will be doing its own thing by healing without being upset by over-zealous exercise.

Hang in there, and try to look on recovery as a marathon, not a sprint. I'm sure you'll continue to improve.

Best wishes!

 

[cycling67]

Jo and Celle,

Thank you SO much for the reply to my post and confirming the information, provided to me by my OS, is logical and confirming my course of action. Yup that "P" word is super, duper hard for me. My head knows that I can get more Flexion ROM going forward but my everything else gets discouraged and frustrated! BUT... what am I to do but to settle in for long haul and keep on keeping on! As you said marathon not a sprint.

One additional question: Pool Therapy -- My OS recommended that I start getting in the pool walking, running in deep end with float belt, etc... I think that this is more for strength than ROM. Just wondered if others had done pool therapy and how it worked for you.

Cheers everyone!
Brenda

 

[Josephine]

Actually hydrotherapy is great! You don't have the constraints of gravity and weight to hinder you. But do be warned, it is awfully easy to overdo it without those constraints. As usual, start off with little and slow and gradually build up.

 

[Nomorepain67]

Hi Brenda cycling67
Still struggling with the p-word? How about some others like purple (my favorite), positive, progress, potential.... I know it is so easy to get stuck on the numbers. I am a week ahead of you and at 124 left and 118 right and I've been there a few weeks. The PT measured my range doing a stretch similar to what Camano76 described. I had to miss a week of therapy due to traveling and when I got back that same stretch I had to push thru to get those numbers was a piece of cake. Put my foot up on second step and leaned right into it. That motion gave me 5 extra degrees than laying on the table and a lot more than measuring sitting in a chair. Maybe your PT could try some different ways to measure, may help you "see" that progress. Also he has me do a rating scale every other week and it is nice to see progress even if it is slow. Told him every week was discouraging. Can do many daily activities that I used to rate as extremely difficult now as having minimal or no difficulty and there really are some of those. Not sure if I can walk a mile with no trouble but was able to stand for 4 hours putting hockey equipment on the littles. Running and changing direction quickly are still zeros but heck running is not part of my vocabulary so don't know that I care about that one
Take care,
Stacie

 

[cycling67]

Update: Hello to everyone! I haven't posted since last November and wanted to provide an update as to my progress as well as seek advice from those experienced to comment on where I am at.

I am now 24 weeks post surgery from my right total knee replacement. As you can read my prior posts on this thread I have struggled with Flexion during this recovery and my patience has been less than stellar.

Stacie: @Nomorepain67 I LOVE what you said about other "P" words... Positive, Progress, POTENTIAL have become my new motto. Thank you so much for your words of wisdom!

My flexion has been and still is slow for several reasons, listed in my prior update: 7th surgery, re-alignment, blah blah blah. All reasons make perfect sense and per my OS will require more recovery time.

I hold out hope to reach 120 degrees of flexion easily. My OS feels like this is VERY possible and feels that by the 1 year anniversary of my surgery I will have it. I continue exercising, stretching, massage, hot tub, you name it I do it.

So where am I at right now?
1. I have about 110 - 112 degress of flexion after warm up
2. I still have immense stiffness in knee in mornings (I think very normal)
3. I can ride my indoor bike for 30 minutes in single session and am working on more resistance
4. I can ride the eliptical for 15 minutes in a single session and am working on longer
5. I still battle muscle issues with cramps and soreness however this is to be expected also given my situation
6. I can walk for about 60 minutes where I couldn't do this at all prior to surgery

I have read many times that increased flexion can continue. I would love to hear accounts of this and general thoughts by the group who has been a part of this thread and any others! @maryo52 @Josephine @speedy2 @rainbird @Celle @Nomorepain67
Thank you in advance and all my best to each and every one of you regardless of your stage in recovery!!!

Cycling67 (Brenda)

 

[speedy2]

Lovely to hear from you Brenda and to hear your progress report.
Like you I have struggled with ROM which still remains at around 90 degrees.
I have returned to work - three weeks before Christmas, part time for the first couple of weeks but full time since then. I am finding that my knee feels much stiffer than it did, especially first thing in the morning and when I have been sitting/standing for too long. I know this is because I don't always have time to do my exercises because of work as when i do it feels less stiff.
I too am enjoying going for a walk when weather and time allows which is a wonderful feeling and something that I am so looking forward to continuing and building on.
Sounds like you are doing just great Brenda.
I'm sure we will get even better...
Big hugs
Speedy2

 

[maryo52]

I wish I had a magic wand. If I did, I would wave it and banish all your thoughts about your knee. You would simply attend to the rest of life and discover one day your flexion was indeed 120. In other words, you'd reach your goal minus all the worry. It doesn't help to be a nice young 46 (I wish I were 46 again!). It's actually useful to be 60-70 when having TKR because, looking back, I fought a lot of battles thinking I was getting somewhere by virtue of my earnest efforts, but most of the time Time was doing the work.

You're only at six months. You can acquire flexion for years. You're way past the point of worry. Your surgeon is confident. So, since there is no magic wand, replace your worry with visualizations of your knee bending at 120 (and beyond).

 

[maryo52]

BTW thanks for your post. It made me think about when I had great bend, so I retrieved this photo (I was 24) for my profile. For a long time after TKR I felt quite impaired. I want to be sure to see myself as able and even athletic as much as I can, for as long as I can.

 

[Celle]

Hi Brenda.
It's good to hear how well you are doing. I know that I continued to increase flexion, slowly, until over a year after my operation. I never measured it, but I would find that I could do things I had not been able to do before.

There is a poster who has recorded her flexion at various stages, to show how her knee continued to improve. I'll tag her - @Campervan - and see if she can post her record for you.

 

[cycling67]

Well said @maryo52
I don't find myself in a state of worry anymore, which is SUCH A RELIEF, but more a state of wondering and thankfully, as you stated, it is not primary on my mind. This, as you know, took like forever for me, but I am there I would say 90% of the time.

You have confirmed what I needed to know that indeed flexion can come certainly months and even years down the road. YAY and what a wonderful thing!!!

For all you cyclists out there, and even those who aren't, I have planned my "year of cycling" events and am pretty pumped up and excited for the goal. My first event is called the Skinny Tire Festival in Moab, UT. There are 4 rides across 4 days, i hope to be able to ride any amount on 3 of the days, BUT if I ride for 30 minutes on day 1 and can't the rest, I WILL FEEL ACCOMPLISHED! It just feels great to PLAN (another "P" word) and not PANIC (bad "P" word).

I would like to say thank you to ALL on this forum for your words of wisdom, words of encouragement, patience with me, and understanding.

To all new people on the list: LISTEN as this group knows of what they speak.

 

[NightQuilter]

A Positive attitude is so vital during our recovery (an on-going thing)! And it sounds like you have a good one. I simply assumed throughout that I would get back to being able to kneel and full flexion - to no pain and stiffness. It was work, as we all know. At 14 1/2 and 13 months, I feel I am pretty much there. I know I have continued to gain flexion - when I left PT at about month 4, I was at @ 130; while when kneeling I don't look like @maryo52 's photo (who does!? ), I would say I have gained about 10 degrees since April. Two mountain hikes in the last two weeks would attest to pretty good balance and, particularly going downhill on treacherous terrain, good stability with deep flexion.

So remain positive! Progress will continue.