[PARTIAL KR] 5 months on worried about muscle wastage and general health decline.

[AnnieLee]

I have looked on here re this issue but only find reference to very fit people regaining fitness by extreme exercise. I am 71, I had PKR to my right knee in January and am due to have the left one done in September. My general decline in health and fitness is terrifying, muscle wastage (where did my calf muscles go?), and general weakness. I try to walk 10000 steps a day and use my exercise bike to try to build strength but my bad knee is holding me back and both legs are constantly stiff, sore and the left very painful. I am fearful that with a further period of enforced inactivity after the second operation is just going to hasten my decline further. I was previously relatively fit and healthy for my age and all I can see now is continuing to go downhill....... am I alone in this?

 

[Jaycey]

@AnnieLee Welcome to BoneSmart! If you give me your exact surgery date I will pop it in your signature for you.

Sorry you are having issues post op. Unfortunately your non-op knee is not going to get any better. And I do think all that exercise is having a major impact on you. No one can really "get fit" with a bad joint. Yes, you may see a bit of atrophy while you wait for your second op. But I would try and do as little as possible so as not to aggravate that knee.

Are you icing and elevating?

I'll leave you our guidelines to refer to:

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 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 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.

 

[AnnieLee]

Thank you Jaycey, my first surgery was on January 21st.
Should I still be icing and elevating the operated leg, or should I do both?
I tried to up my activity because I was so afraid of feeling so weak, and also gaining weight. I will try resting more as I don’t seem to be achieving much anyway.

 

[lovetocookandsew]

Hi, and welcome to BoneSmart!

but only find reference to very fit people regaining fitness by extreme exercise

I don't see only people here who use extreme exercise as you mentioned; I do see many people who have lost mobility due to knee issues, who need advice on how to regain strength and function after surgery. BoneSmart doesn't promote extreme exercise after a TKR or PKR; on the contrary it's a more gentle approach to recovery that's promoted. That doesn't mean we suggest patients become couch potatoes; rather that they start off just doing activities of daily living, and gradually progress to more active lives like they were living before they had knee problems and knee surgery. There are some patients here who post about their strong exercise-oriented recoveries, and we cheer them on when it works for them, but for the most part BoneSmart advocates a "kinder and gentler" recovery progression, so to speak. We don't advise "enforced inactivity", rather a phased progression of activity that allows your knee to recover from surgery, but doesn't overdo and cause more pain and swelling in an already stressed knee.

If 10000 steps is too painful for you, maybe you need to rethink that approach for now. It is only five months since your surgery, and you're needing surgery on your other knee due to problems there also. I would do whatever your knees allow you to do without causing too much pain, and allow the surgical knee to continue it's recovery while not stressing your other knee too much.

I think that once you have two good knees, and they're both recovered, that's the time to begin to strengthen them again. Right now it seems to be causing you more pain than you can take (as is normal with knee issues). You're in a double quandary with one knee recovering and the other needing surgery, so I suggest listening to your knees and if they hurt too much or swell, etc, back off until you find a happy medium where you can continue to recover the right knee while not stressing the left knee. It's a hard place to be, I know. Just know that you're not alone, and people here will support you, and care about you and your journey. Please, keep us posted and feel free to ask any questions you have, we are here for you!

 

[lovetocookandsew]

I found icing and elevating to be the best form of pain relief for my knee. If it helps, by all means continue doing it. (Don't forget to put a cloth between your knee and the ice or ice machine wrap) Even now, at a year out, I have days when icing and elevating my knee feels good and is helpful. The recovery from knee surgery takes, on average, a full year, and your surgical knee is at 5 months, while your other knee is still waiting to be repaired, so your double whammy makes it harder on you.

 

[AnnieLee]

Thank you so much for all the advice, I have been pushing myself too much recently out of fear, so I am certainly going to give myself a break and relax about it, I didn’t seem to be getting anywhere anyway, just making matters worse!

 

[Jaycey]

Should I still be icing and elevating the operated leg, or should I do both?

Yes, especially if you are sore and stiff. Ice both knees - it may not help the bad knee but do give it a try.

Please don't worry about your fitness level right now. Once that second knee is addressed you will be able to move around more and slowly increase your activity. For now, baby that poor, worn out knee.

 

[Jockette]

Hi and Welcome to Bonesmart!

We all lose some temporary leg strength as a result of this surgery that causes a lot of trauma, while correcting our arthritis issue. If you give your leg time to heal properly, you should regain that strength later on.

for the most part BoneSmart advocates a "kinder and gentler" recovery progression, so to speak. We don't advise "enforced inactivity", rather a phased progression of activity that allows your knee to recover from surgery, but doesn't overdo and cause more pain and swelling in an already stressed knee.

Very nicely worded.

 

[Celle]

Hello @AnnieLee .
What the others have said makes a lot of sense.
Yes, you have lost muscle strength, but it will come back, even with ordinary daily use.

The thing that no one amongst your medical advisers seems to have told you is that recovery from a knee replacement (total or partial ) is a long process. Complete recovery of all your wounded tissues takes a full year. Knee replacement isn't the sort of surgery you can bounce back from in a few weeks.

Your fitness level will come back gradually, but you can't make it come back faster by exercising.
How you feel now is not how you'll end up. There's no reason why you shouldn't end up as fit as you were before the surgeries, but with two new knees that don't have that awful arthritic pain.