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Bilateral TKR 13 Months and Counting

DOUBLE TKR

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First, I am struggling a little to figure out how to plumb the depths of this wonderful web site. I'll get there! My two-week post-surgery PT evaluation showed flexion at 75 degrees and extension still 10, and this was after faithfully using my continuous passive motion (CPM) machine and icing. Somehow, I felt discouraged, even though I have no idea whether that's in "normal" range or horrible or OK. My first PT is today, Monday, June 25, 2018. I have friends and family who have total knee replacements and can do yoga and have all kinds of flexibility and I'm wondering if I'll ever actually get there. There's an emotional component to this recovery I wasn't prepared for. I am not in much pain as much as I'm really stiff. My first thread.
 

Spex10

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You've just had a double? Are both knees at 75?
 

Jockette

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Welcome to Bonesmart, you posted just fine and in the right place, too!

That’s great that you don’t have a lot of pain! The stiffness you are feeling is swelling. Over time that will diminish.

PT can be useful, they can do an awesome massage on your thigh that will feel good, that is to help move the swelling through your system. Do be careful, though, not to let them hurt you. Many PTs feel, and will tell you, it’s necessary to force bend your knee. It is not necessary, so don’t let them. Been there, done that, and that will not happen to me again.

Your friends and family who are doing all those fun things are long healed and at 2 weeks post op they were where you are now. Where you are now is not where you will end up!

This is a long recovery that requires a lot of patience, but you will get back to doing things as you continue to heal.

Best wishes!
 

KarriB

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Welcome to BoneSmart! I’ll leave our recovery guidelines below for you. It can take awhile to get back to the physical activities we love, but everyone is different and recovery can look different for each individual. Extention usually comes later in recovery, so no worries there and 75 at 2 weeks is great!

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. Here is a week-by-week guide for Activity progression for TKRs


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.
 
OP
OP
DOUBLE TKR

DOUBLE TKR

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Welcome to BoneSmart! I’ll leave our recovery guidelines below for you. It can take awhile to get back to the physical activities we love, but everyone is different and recovery can look different for each individual. Extention usually comes later in recovery, so no worries there and 75 at 2 weeks is great!

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. Here is a week-by-week guide for Activity progression for TKRs


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.
Thank you!
 

SusieShoes

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Hi @DOUBLE TKR and :welome:

If you would tell us the date of your surgery we will create a nifty signature for you. Having a signature with the surgery date helps members and staff give advice appropriate to your stage of recovery. :)

I had both knees replaced also. Each knee is an individual and may heal slightly differently -- a little slower or faster, with different milestones for ROM, and possibly pain that's unique to it. Your ROM for two weeks is in the ballpark. It will get better as the swelling in your knees goes down.

It's also normal to feel discouraged. :console2: This recovery takes a lot longer than 1) we're told by our medical team, and 2) other people who had TKR remember! My mom, for example. I took care of her after her knees were replaced. Twice. And she will swear she was perfectly well recovered in six weeks. Um.... no. It took longer, though she was quite the ace. Today she sits on her feet. I can't do that. Yet. But still, she was not doing that at one month or even six months!

The best thing you can do for your knees is elevate them as much as you can. I was off my feet with legs up on my foam wedge 95% of my day. And yes, I slept that way too (hurt less than any other position for the first months). Elevation and icing are excellent for reducing swelling in the knee... and less swelling means less pain and more ROM!
 

Celle

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Thank you for the surgery date. Your signature has been edited.
First, I am struggling a little to figure out how to plumb the depths of this wonderful web site.
We have lots of "How to . . . " articles in this section:
https://bonesmart.org/forum/view/how-to-use-this-forum.74/

Articles include this one, so you don't have to quote a message ,in order to respond to it:
How to use the quote feature

My two-week post-surgery PT evaluation showed flexion at 75 degrees and extension still 10, and this was after faithfully using my continuous passive motion (CPM) machine and icing. Somehow, I felt discouraged, even though I have no idea whether that's in "normal" range or horrible or OK.
Range of Motion (ROM) of 75 and 10 is OK for only 2 weeks post-op. Most surgeons don't expect 90 degrees until about 6 weeks, so you're well on the way.

Using the CPM machine doesn't always help and it makes no difference to your eventual ROM. Just a little exercise is all your knee needs at this stage of recovery, so don't let the PT therapists overwork it.

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR
 

DebM

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You are just at the beginning of a marathon. Patience will be your best friend. You will heal at your own pace so take no notice of what neighbours, friends of friends etc did.
Most importantly take note of the advice from folks on here. We have all been there.
 
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DOUBLE TKR

DOUBLE TKR

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I have read every article in the list of links and was armed to the teeth with arguments against aggressive PT and, more than arguments, my own line in the sand. Turns out my therapist totally agreed and the session was quite satisfying. Thank you so much, BoneSmart. What a gift and I will let anyone and everyone I know who may be facing joint replacement about this web site and support group.
 

sistersinhim

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I was blessed to have found this site 6 months before my tkr. I had a meniscus repair and scope in November 2017. I was told afterwards that I really needed a tkr. That's when I started looking for a surgeon and for information on the surgery. Bonesmart popped up in my search! I had had 10 previous knee surgeries and knew that formal PT wasn't needed to rehab a knee. To find a site that agreed with my thoughts that aggressive therapy was actually worse for a healing knee than gentle, everyday activities was such a relief! I was prepared, because of Bonesmart, for the long recovery time for this surgery. My OS had told me that I'd probably hate him for at least 3 months, but that's all he said about the long recovery time. I never did hate him, but did hate that I had had the surgery!

Finally, after the first month, I was seeing a tiny light at the end of the long, dark tunnel! Those baby steps were getting more frequent and more adult like! Yours will, too! It just takes patience!
 
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DOUBLE TKR

DOUBLE TKR

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Tomorrow is five weeks since surgery. I have made very good progress with extension with only discomfort, not pain. Because I am nearing zero (from -10 and -15 4 weeks ago), I can stand up straighter, which helps me stand comfortably for longer periods of time. So I am learning about the importance of extension. However, I am fighting some anxiety about flexion, as I don't think I have made any progress. So far, my PT time is much more focused on extension, thankfully. My knees just don't want to flex further than about 75 (my guess) which is where they were weeks ago. Right on cue, since I read the article about discouragement being a normal part of recovery, I cried last week when I got to PT. Will I really ever get better? I am much more active now, as I am helping care for cats and helping cook and generally just much more functional -- as long as I don't need to bend my legs very much. I am icing 2-3 times a day and doing very gentle flex exercises -- pain, no gain -- but am having a hard time believing my knees will ever stop feeling so tight and painful at a certain point of flexing. Sigh. Clearly I am not in the fast lane in terms of recovery. I think I'm afraid that something is wrong. Not sure how to combat that. I printed out the images of recovery times for one knee vs. both knee replacement surgeries and I can see that six weeks seems a kind of average for beginning another level of progress, but I find it hard to believe another week will make much difference. I keep telling myself that ROM can (will) continue to improve for months, but I'd sure like to experience some improvement sooner than later.
 

sistersinhim

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Oh man, please be patient. You are a little over 1/12 of the way of being healed. You are doing too much and keeping your knee swollen. That swelling is holding back your bend. As the swelling goes down, the bend will increase! Here are just two of the many examples of ROM increasing as time goes on:

One of our members, Bertschb, kept a record of his ROM process. He agreed for us to post it for those of you that are afraid you're stuck. The key is to have patience! Bertschb says:

I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.


This is what one of our members wrote about the slow development of her ROM. (Thank you, @Campervan ) As you can see, her flexion continued to improve for a long time.

"I had a slow recovery. Here's my flex measurements at various points:
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months
128 – 6 years "
 

Celle

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Will I really ever get better? I am much more active now, as I am helping care for cats and helping cook and generally just much more functional -- as long as I don't need to bend my legs very much. I am icing 2-3 times a day and doing very gentle flex exercises -- pain, no gain -- but am having a hard time believing my knees will ever stop feeling so tight and painful at a certain point of flexing. Sigh. Clearly I am not in the fast lane in terms of recovery.
It's only just over a month since you had this major surgery - and on both knees, too.
It sounds to me as if you're doing really well, but you're expecting too much, too soon from your knees. Recovery from a TKR takes a long time - as long as a full year for complete recovery of all your wounded tissues.
It's a marathon, and you're expecting a sprint.

Don't worry about your flexion. It will come, as time passes, your knees heal, and the swelling goes down.
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

You said "Pain, no gain". I hope that was a typo, because "No Pain, no gain" is the wrong approach for this recovery. Myth busting: no pain, no gain
Listen to you knees and remember this:
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.

Yes, one day your knees will stop feeling stiff, but not just yet. That stiffness can linger for quite a long time, although it should decrease gradually. If you do too much, stiffness and swelling will increase, so check your activity with this article again - Activity progression for TKRs
 
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DOUBLE TKR

DOUBLE TKR

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Celle and Sistersinhim, thank you. Celle, I actually meant "pain, no gain," based on BoneSmart's advice to not let PT, or your own knee slides, for instance, cause pain. I am blown away by the ROM stats that sistersinhim shared. Wow. A friend of mine had bi-lateral TKR over 20 years ago and 1) she went through 4 weeks of in-patient PT 3 times a day and 2) walked out 4 weeks later with full ROM. Maybe her memory is faulty, but that blew me away and when I told her that I was still pretty stiff and not flexing much, she said that was too bad and was concerned about it. I told her I was actually doing pretty well, but it bothered me. Frankly, I wonder how much unnecessary pain she endured. I do think when I have a day when my knees feel pretty good, I get more active -- which feels so good! -- and then pay for it a little bit the next day. This is a heck of an experience.
 

sistersinhim

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Oh yeah, this is a cause and effect recovery. Two steps up, one step back. Sometimes one step up and two steps back. But, there is an end to it all, and it has a wonderful, arthritis free end with the knees!
 

SusieShoes

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Maybe her memory is faulty,
Memory for all of us is faulty more than not. I had three children and don’t remember one bit the pain of childbirth. Our brains are wired to forget some kinds of pain. Doing so persuades us to do things to which we otherwise would say, “:censored: no! Never again!” Surgeries generally fall into that category.

My mom had her knees replaced, two separate occasions (wherein I had bilateral) and I was her caregiver both times. She had a wonderful recovery and is a stoic soul. To hear her tell it today, she was fully recovered at one month. This is not true. I remember she took a few months at least, though because she never complained much it was hard to tell about how much pain she was feeling.

I think a relaxed approach to TKR recovery does wonders. My mom was relaxed (she didn’t go to PT and mostly rehabbed her knee on a stationary bike) and so was I. Doing recovery your way and not some therapist’s way has quite a lot of advantages: you feel in control, you set the pace, you feel less pain (because you stop before it gets bad), and you progress by doing things you enjoy. Mom rode her bike; I walked around my pretty neighborhood. I have a cousin who actually likes housework and swears she rehabbed her knee with dusting. :shrug: There’s more than one way to rehabilitate new knees!
 

Chattalyn

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ROM will continue to improve. I had bilateral, was in hospital 6 days(needed blood transfusion), rehab for 5 days. I also had lateral releases on both and bone spurs removed and was still using a walker for my gait at your stage. Slow and steady does work. You'll keep seeing improvements. Reread the info from Bonesmart, ice, and elevate. Hang in there.
 
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DOUBLE TKR

DOUBLE TKR

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Tomorrow is six weeks from surgery. Decent extension, no improvement on flexion -- not measured recently, but probably not more than 75. Scooting around the downstairs pretty easily using my walker, doing some cooking and cat care, helping with other kitchen chores. I have an appointment with my surgeon this coming Friday (7/20) and I'm nervous he has some expectation about ROM. I read and re-read BoneSmart advice so I'm ready to push back if I feel like he or PT wants to push me beyond what I need or want. Knee stiffness still profound. I am icing at least once a day using my ice machine (sent home with me from the hospital) and sometimes another time or two with ice packs. I elevate my knees when icing. I struggle a little with concerns about ROM -- so much noise out there in the outer world about it!! -- but I am pushing against that little bit of anxiety and reminding myself that I still need a lot of time to heal. I feel like I am lucky because I need very little pain medication, but I do need some. I take 1/2 pill (Norco) 2-3 times a day. Most surely in the morning, at least.

Up to a week or so ago I couldn't get out of my favorite recliner because it's a little lower, it rocks (slightly), and the arms are lower and very softly cushioned, so I had a hard time pushing out of it. My husband had to help me get up from it! But, I just had this feeling yesterday that I wanted to try again and by golly, I was able to get out of it with a bit of concentration. I felt excited because it felt like progress. It's just nice to have something else to sit in for a little while. I actually went to a movie and was able to keep my knees elevated. It was nice to get out. At this point it is so hard to believe that at some point I will feel normal again. I keep believing!
 

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