TKR 3 Weeks Post Rt TKR

[hjh1869]

New member looking for some encouragement. 52 year old female with 6 prior surgeries including 5 arthroscopic and 1 ACL reconstruction. TKR 1/21 right knee. 5 days post op indescribable sciatic pain left side. Had been dealing with this for about 18 months prior but was at a good place before surgery. The night before had a massage and chiropractic adjustment as a precaution in case this happened. It has taken over my life. My knee pain is nothing like this. Haven’t slept in weeks because each side requires a different position to be comfortable. In home therapy 5 times in weeks they were happy with my progress although I could not reach full extension. My 2 weeks post op at surgeon and she was not too concerned. First day at outpatient measured -15 and 95. Each session starts with 10 mins of 10 pound heated pad to help with extension. Currently can reach -6/99. We also do 30 mins of sciatic stretches because it hampers the opposite side knee exercises. Knee feels heavy. I have started massage as the scar has healed well. Just looking for others 3 week experiences not necessarily with sciatic issues. Feeling a bit discouraged at the range right now.

 

[Jockette]

Hi and Welcome!

I‘m sorry you are having such painful sciatic issues, in addition to recovering from a TKR.

although I could not reach full extension.

Each session starts with 10 mins of 10 pound heated pad to help with extension.

There is no need to put any weights on your leg to help with extension, and especially a 10 pound weight. Your extension will come along fine as your swelling goes down and as you heal. You are still very early in a recovery that takes an average of a full year. You might want to consider declining this option at PT.
Saying no to therapy - am I allowed to?

Here are two gentle exercises we recommend, and are really the only ones you need:

Extension: how to estimate it and ways to improve it
Heel slides and how to do them properly

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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

​

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 to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[hjh1869]

Thank you, I have been worried reading about MUA and was really hoping my current range wasn’t of concern.

 

[Jockette]

Your range is fine, so don’t even think about an MUA at this point. And, MUA is done for the bend, not for extension.

Sometimes our medical teams can cause us a lot of stress about our ROM (range of motion) They want us to recover it right now! But, we all heal at different rates, and some of us swell more than others, and those are the two factors that affect our ROM. It is way too early for you to worry about it.

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.

 

[FCBayern]

Welcome to BoneSmart @hjh1869! I think you mean your extension is +15, -15 would have your knee bent backwards by 15 degrees. Extension was really slow for me to regain as well. I was still at +4 at my one year mark, but at the end of the second year I'm -1. Your ROM will come with time and patience. In the mean time

 

[Newkneenewme]

Hi! I am 13 days post RTKR and have almost the same measurements. My physio says -20 and 90 as of last week, I see her again this week and I’m hoping for some progress. Leg straightening was a huge worry for me in my LTKR in September but it came along quickly with physio/gentle stretches over the course of a few weeks. I was really stressed about it then and I’m still stressed about it this time around despite the fact I just went through it!!! Interested to see how you are doing as time goes on!

 

[Celle]

I think you mean your extension is +15, -15 would have your knee bent backwards by 15 degrees.

Just to clarify:

 

[Cococay]

I read a post you wrote in another thread and it feels so much like what I just posted- sciatica and hip pain on opposite side are preventing me from walking. I’m curious what your OS or OT thinks will help.

 

[hjh1869]

Tomorrow marks 4 weeks. This week noted some significant progress with the debilitating sciatic pain and knee ROM. I’m now at nearly zero and 110. I can ride the recumbent bike a mile in 6 mins. I do both back and knee rehab so it’s exhausting. I’m still not sleeping and have constant sciatic pain but it’s better. Today, although exhausted everyone who saw me said I looked remarkably better. I definitely feel better. Hopefully the worst is behind me. This is the knee at 3 weeks

 

[hjh1869]

I think you mean your extension is +15, -15 would have your knee bent backwards by 15 degrees.

Just to clarify:

I was lacking 20 degrees from full extension -20. Hyper extension of 20 degrees would be recorded as +20. The graph dictates it correctly with the blue indicator. The knee is not flat at zero it is -10 degrees to being full extension

 

[Celle]

It's a US thing to express it the way you do, @hjh1869 , but it isn't correct.

Yes, you are 20 degrees away from full extension, but that is the same as a flexion of +20 degrees.
Your knee can't straighten fully yet, but it will get there.

The blue -10 degrees is correct and if anyone had an extension of -20 degrees, the blue line would be twice as high as the blue -10, which is pretty much impossible, unless you have abnormally lax ligaments.

Extension often takes longer to achieve than flexion does, so don't worry about it. It will come, as your knee heals.

It's only a month from your surgery and you're doing very well. There's no need to rush to get ROM because both flexion and extension 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

 

[hjh1869]

40 days post RTKR....overall not many complaints, sciatic issue somewhat resolved with therapy and an ESI, however for due the past 10 days a have some pain and soft tenderness on the outside of the knee. I should add that my IT band in the thigh area, hamstring and calf are extremely tight, like ridiculously hard. Could this be related and possibly part of the IT band? I see OS Fri for 6 week FU