TKR 3 Months out of TKR with extreme stiffness - looking for similar experiences

[staceydawn]

After over 10 years of debilitating bone-on-bone pain in my left knee, at age 59, I finally gave in and opted for a Robotic Zimmer Biomet TKR. The fit was supposed to be nearly exact. Personal history: I was very active my whole life, a former runner turned distance walker, hiker & biker, in good physical condition and optimal weight to go into this surgery with a positive outlook. A month after the surgery and plenty of hard-core physical therapy, it was clear that parts of my incision had not healed properly. After the incision finally closed (with much difficulty) I have been spending most of my days unable to walk without a limp, and the stiffness in my new knee is so uncomfortable and always present. Even though I can painfully bend to 125 degrees, I still don't feel better than I did before I went into this surgery. I have never been a depressed person, but I am constantly crying, wishing I never did this surgery, even though I was at my wits end with my severe limitations. My surgeon, PT, and everyone keeps telling me I won't feel "normal" for a year after surgery (which no one told me prior to surgery). But the strain of my limp on an already compromised lower back is keeping me from feeling hopeful. Did my incision complication cause the stiffness? Am I doing too much painful PT? Should I switch my dedicated, very experienced PT to someone new? I'm beside myself as I wonder if this stiffness will ever subside and allow me to walk and live normally again. Attached is a photo of my scar at 3 months.

 

[mendogal]

Welcome to BoneSmart! I will post some general post op info and then return with more specific info to address your concerns.

You are in the very early stages of an average of a yearlong recovery. I will leave you our Recovery Articles that have helped tens of thousands of other knee replacements. We are here to help you through this journey the best we can. The very best thing for your knee right now is to rest, ice, and elevate. Exercises can come later. There is no rush to achieve ROM because it will come naturally as your swelling decreases. Your OS was able to bend your knee while checking for movements during your surgery, so it will be fine. It just takes time.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

KNEE RECOVERY 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.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

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​

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.

 

[MetalKnee]

I wouldn't worry. The surgeon did the easy part and now the hard part is up to you. That's what my surgeon told me right out of surgery. Just keep doing your exercises and stretching and it will improve. I believe but don't know, I think they shoot your mussels you with a chemical that turns them to jello so they can pull them out of the way because nothing is cut. This took me a long time to recover from. I would think your PT is helping push on your legs to get your range of motion back. That year out thing is a good one. I'm almost 2 years out now and love my new knees!!

 

[MetalKnee]

I did read your post and have about the same story. 10 years of knee going bad and I was a very active person. I'm 2 years older than you. I looked at the pic and swelling did look too bad. Stay positive and keep moving it. It will keep improving!

 

[mendogal]

Looks like your left leg - If you provide the date of surgery we will create a custom signature so members can see your recovery status at a glance.

To address your concern: YES it is very common at three months to have painful stiffness even with a good range of motion.

PT that forces a bend, and that encourages you to do so, is counterproductive because it's hurting healing tissues and creating more swelling. The swelling may not be very visible but the knee capsule is contained and when it is aggravated the swelling inside it has nowhere to go so the flexion attained triumphantly on the PT table evaporates that night when you're hurting. A swollen knee simply can't bend.

Many of our members find that if they back off from aggressive PT and give the new knee time to heal that the flexion comes. It sometimes takes a year or even longer - we will share some member's progress in another post.

What to do?
First, ice and elevate "toes over nose" for 45 minutes to an hour several times daily.

Second, if you're limping, please go back to using a cane or walking stick until you can regain proper structure. Not only are muscles, tendons, and ligaments healing, but your entire structure that had mal-adapted to your arthritis got reset in OR and is trying to recalibrate. Not an optimal time to be limping!
With the cane try to focus on heel to toe walking.

 

[EalingGran]

I am sorry you are suffering and feeling really fed up. Like @mendogal says it is still early days and doing too much may have aggravated things and slowed you down a bit. Try being more gentle and easy on yourself. I note that you are an ex- runner- so I wonder if your expectations were very high and you pushed yourself a bit too much?

 

[Jockette]

plenty of hard-core physical therapy,

Hard core PT does not help us heal. Your knee/leg/body has been through a major surgery which caused a lot of trauma from which you have to heal, which takes time.

I have never been a depressed person, but I am constantly crying, wishing I never did this surgery, even though I was at my wits end with my severe limitations.

Almost all of us felt this way at some point, it can happen after any major surgery. Here’s an article about it from the Bonesmart Recovery Guidelines:

Post op blues is a reality - be prepared for it

Post op blues is feeling depressed, weepy, nervy, shaky, fearful of the future, anxious, overwhelmed by what is happening to you, convinced it's never going to get any better and finally, uttering that most intense of all cries "I wish I never had this done!" It arises out of a variety of...

bonesmart.org

My surgeon, PT, and everyone keeps telling me I won't feel "normal" for a year after surgery (which no one told me prior to surgery).

This is another thing many of us were not told. I wasn’t, and I wasn’t happy to learn about it afterwards.

Am I doing too much painful PT?

Probably. It seems most PTs really don’t understand what our body goes through in this surgery and they focus on the mechanics, and don’t realize how long healing takes. If you really like your PT, have a conversation with him/her about how you feel, how what they’re having you do doesn’t seem to be working, and tell them you’d like to do a gentler rehab. Then, see how they react, then you can decide if you want to change locations. Just because they are very experienced doesn’t mean they were trained properly in rehabbing s joint replacement, and you’d be surprised at how many are not!

You might even consider doing your own rehab at this point. I only went to PT for 8 weeks. By then I know what to do and what was in my best interest. I rehabbed on my own, at home.