TKR 5 Years Post Op

[dvannie]

Unfortunately I've fired another PT. the Monday went well with no ill effects so I was actually looking forward to the next appt on wed. That appt didn't go as well, I ended up with a lot of swelling and my back in spasms. It took me the next day of icing and elevation to get it somewhat under control. I was determined that today I would not allow the same things to occur and would explain to her that I couldn't have a repeat of the previous appt. unfortunately it went worse and even though I told her to stop, she continued and I almost passed out from the pain. She then measured me and surprise surprise I was going in the wrong direction and had lost over 5 degrees. That's when she offered to take me into one of the rooms and get me to bend and then she would quickly force it the rest of the way. I said no thanks and now I need to make a decision.

The surgeon wanted 90 degrees by the end of next week which quite honestly is not going to happen. He wants to do a MUA. I'm not entirely against it but I'm torn that if I go my own route and pace, what happens if there's something wrong with the replacement that's causing this whole stiff issue. I'm uncertain whether I'll still have his support if I say no to the MUA. I'm so confused about what to do next since there is a window for the MUA between 6-12 weeks, which I'm just entering now.

Diane

 

[Pheebs52]

@dvannie, this is such a hopeful, positive post; yay! It sounds as though you are very pleased with your therapist and that makes such a difference! Did she do a lot of massage? I find that very helpful. Mine doesn't push on my knee, nor has he wanted to, nor would I allow it; hah! But, I have let him move it very, very slowly to get a good quad stretch. I actually enjoy it, and never feel any ill-effect afterwards.

How great is it to have your furry buddy back home; yippee, for him and for you!

Here's to wishing you more great recovery stories to share! Cheers!

 

[Pheebs52]

Oh dear, I see I have responded to your Tuesday post and not your most recent one; sorry! How awful to have had another painful, nasty PT session and a PT who just doesn't listen! Have you considered just doing the Bonesmart exercise routine and getting no PT at all? That said, I don't know if any here that did not have PT were cursed with a non-bendy knee at almost 6 weeks. Psychologically, I do think it's all much more stressful for non-benders, especially if dealing with an unsympathetic surgeon.

I completely understand your dilemma regarding the need for the surgeon's support, yet not wanting to go for the MUA yet. It seems to me you still have quite a bit of time to see how your knee improves before an MUA should be a consideration? I don't think that *window* of 6-12 weeks is exactly right, of course, I could be wrong. Many surgeons seem to want 90 degrees at 6 weeks, but not all. Mine would like to see 100 between 8-12 weeks, but certainly hasn't threatened me with MUA. I've no idea if I'll get close to that or not in that time frame, nor do I know what he'll suggest when I see him again on 7/25. I feel anything could happen in the next 4 weeks, so am not really concerned at this point.

I wonder if there are some other, formerly "Slow-Benders," who ultimately met with success and could offer you some information and insight? I know there are several others that have gone the MUA route and met with success, so a view from both sides of the equation might be helpful.

 

[Clipless]

Hi dvannie, I hope it's okay if I jump in here. My LTKR bend barely reached 90° after 8 weeks (it was 88°) but I didn't need MUA. That knee was slow coming around and had considerable post op swelling. There was severe quad atrophy due to longstanding post-traumatic damage, and further muscle inhibition from the surgery itself. My OS knew that when the quad "woke up" the edema would naturally work itself out of the joint and I'd achieve more bend. I didn't believe him at first but he was right. The entire process took a long time, though. I still had some residual swelling and pain 8 months post op but now- 2 1/2 years later- it feels great!

Though I'm not saying you should entirely rule out an MUA I'm pretty sure you shouldn't be worrying about it so much at less than 6 weeks out. Also, PT pushing is not what gets you more flexion in the early days- it's getting the swelling down, using your quad a little, and gently bending on your own- no help needed.

P.s. I had RTKR a year after LTKR. My flexion is now ~125-130° in both knees, in other words- pretty good!

 

[KarriB]

You are just 5 weeks post op, there is time for your knee to gain ROM. Your knee isn't bending because it needs more than a day to recover from the aggressive therapy. My advice would be to take a few weeks off from PT, spend time elevating and icing while getting on with ADLs. Some people do need an MUA, but 5 weeks is early for one, especially when your knee could use some time to settle down. An MUA usually results in a very swollen knee at first and actually restarts your recovery because of the trauma to the knee. The only way to know if you truly need one is to give your knee a break and reevaluate in a few weeks. An MUA is your decision, you can say, yes, no, or later.

 

[SusieShoes]

I'm going to throw my hat into the "less therapy" ring. Maybe you could take a break from PT for a couple of weeks, just give your knee a rest and do daily activities, and see what happens. If aggressive therapy is causing your swelling, the swelling should go down, and then you will know. Also, if the swelling goes down, you will bend better... and then you will know how your knee wants to get its bend back.

 

[Jennszoo]

Even if you buy into his "window of opportunity" Bs, the way I see it, you still have 7 weeks to play with. So yes, tell him you understand, blah blah blah and ask for another month. In that month, follow the bonesmart way, stop with the PT and see what happens. No reason the MUA has to be scheduled this week.

 

[Celle]

@dvannie
There's no window of opportunity for gaining ROM and no window of opportunity for doing an MUA. Plenty of people have had an MUA well after 12 weeks, and ROM can continue to increase for a year or more after a knee replacement. It's true that the surgeon needs to take a little more care if doing an MUA after 12 weeks, but it can still be done.
Myth busting: the "window of opportunity" in TKR

He wants to do a MUA. I'm not entirely against it but I'm torn that if I go my own route and pace, what happens if there's something wrong with the replacement that's causing this whole stiff issue.

Many surgeons want you to reach 90 degrees by 6 weeks, but most are willing to wait to do an MUA as long as you are making some progress, no matter how slow it seems. It's your knee and you are the only one who has the right to say what will happen to it, so just tell your surgeon that you would like to wait a little longer before discussing an MUA. You have plenty of time.
Saying no to therapy - am I allowed to?

It's million-to-one chance that there is anything wrong with the implant and even if something was wrong an MUA wouldn't fix it.

I'm totally convinced that the only reason your knee isn't bending better now is because of over-enthusiastic PT, which is keeping it inflamed and swollen. I agree with the others - stop going to PT and just let the activities of your daily living be your exercise. Spend lots of time resting, icing and elevating your knee, to try and help the swelling go down.
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.

I wonder if there are some other, formerly "Slow-Benders," who ultimately met with success and could offer you some information and insight?

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"

 

[sistersinhim]

There are quite a few of us on here that never did PT. I am plenty experienced in knee surgery, 11 of them with NO PT. Your knee isn't in bad shape that needs to build muscles back up. Your knee needs to heal! Go on YouTube and look at a real time video of a TKR. Your two main bones were sawed off, with implants pounded into them. All your muscles, tendons and tissues were pushed out of the way. And then put back together. Just look at what was done to close it:
https://bonesmart.org/forum/threads/closing-surgical-wounds-how-is-it-done.4286/#post-90691

All you need to do right now is to heal. Stop all PT and just do what you need to do to live. That's what all of us did that didn't do PT. We got well and wonderfully functioning knees without any of that agony of PT. Try doing no exercises for at least a month. You won't back-step. Your swelling will go down and your ROM will improve. Trust us who are experienced. We will not steer you wrong.

 

[dvannie]

Thanks for your posts. I have considered going the BoneSmart way, I'm really in no rush for the bend to fully happen, I don't mind being patient and it taking awhile. The last improvement of 15degrees was a result of me taking a week off PT. I talked it over with my hubby and he's starting to understand what's happening, that as soon as I'm making progress, the PT messes it up and my knee is noticeably more swollen in the hour that I went to PT. My husband was horrified by this last visit and Had he he been with me, I don't think he would have been very nice with them.

As I said the only reason I was considering a MUA is I'm worried my surgeon may fire me and I will be without a surgeon to check on it. I'm going to take at least this long weekend to think things over and figure it out. It's somewhat understandable that my bend is taking awhile. It was so bad previously and I could hardly walk without a leg brace and cane before the surgery.

I'm leaning toward taking the next two weeks without PT and seeing how they pan out. I keep telling my hubby that I have a feeling that if I can just start doing day to day things and forget about fixating on my bend, if will come to me. Besides which, it's going to take me at least two weeks before I see the surgeon anyways. I just know that regardless, I'm not going back to PT.

Thanks for your suggestions and support!

 

[sistersinhim]

Yay! ! You've got the right idea! It will work for you. BTW, your surgeon can't fire you. He works for you, not you for him. He is your employee, as is PT. You have the last say so, nobody but you!

 

[Clipless]

Your surgeon won't "fire" you- no way! If he is the prima donna-type or has an intimidating manner bring your husband or a friend to the next exam for moral support. Sometimes it's just that our confidence is at a low ebb when we're not feeling well. My OS is the nicest guy in the world, yet I dreaded his disapproval so much that I rescheduled one of those early appointments (I think it was the 6 week) for a couple of weeks. By then my confidence (and bend!) was improving. He had a few suggestions, but he didn't even ask about PT!

 

[liam2015]

@dvannie ~ i'm a fellow slow-bender and in my case, i didn't do physio until 6 weeks due to being nauseous and wanting to take care of myself. i still have moderate swelling and my knee is gradually gaining r.o.m.; however, with the help/push of the physiotherapist. i do the bending exercises at home and it seems like i'm improving but it still took some push today by the physiotherapist to get me to 95 degrees and i'm a lot further along than you, going into my 11th week. it's stressful being slower to recover, wondering if everything will eventually get there. can you tell your surgeon that you feel you need to progress at your own rate and need a break from physio, that you'll play it by ear up until the 12th week, the supposed window of opportunity, before you'll decide what is best for you? my surgeon finally accepted that i would progress at my own speed, so long as my r.o.m. continued to improve; however, he still wants to check me once a week until i get to 100 degrees. for whatever reasons, we don't want to lose our surgeons.

i think it's a good idea you have, to take a break from physio, and you can see if the swelling goes down and your bend improves. you can work on the functionality so long as you don't overdo it. you can rest up, elevate and ice and see if that helps. let us know how it goes. remember, you're not alone, no matter what you decide to do.

 

[KarriB]

A two week break from PT before seeing your OS is perfect. It will give your knee time to settle down. Don't worry about the ROM, just concentrate on keeping it elevated as much as possible. I was so glad to hear you didn't let the PT push or "help" your knee in order to get a better number. It is definitely not good for your knee and most likely a reason for the swelling.

 

[Pheebs52]

@Celle, thanks so much for posting CamperVan's slow-bend experience! That did wonders for my morale and I'm sure for many other Tortoises here!

@liam2015, makes a great point when she says "for whatever reason we are afraid to alienate our surgeons." Well, yes, we are. After all, if something should go wrong, who would we turn to? Even if nothing goes wrong, who would check our progress? I've experienced this first hand after having had THR and needing a cortisone injection for trochanteric bursitis. I didn't wish to return to the original surgeon for a number of reasons and wanted to find someone local. It didn't happen. Not one of the locals would touch me with a ten-foot pole, just because someone else had replaced my hip.

 

[liam2015]

@Pheebs52 ~ i'm not sure how it is in the u.s., but here in canada, it can take months to just get a first appointment with certain specialists. i was on a 10 month waiting list for the surgery (after first surgeon meeting) and it would have been even longer had not someone cancelled and they phoned me. having said that, someone in worse shape than me would have been moved up sooner. my surgeon is young and has my best interests at heart and i'm sure he wants to make sure that his work is successful. it will take time for this "gentler healing protocol" to be learned by the surgeons who have been taught the "no pain, no gain" protocol. wow, Pheebs52, that must have been discouraging that you had trouble finding another surgeon that would treat you.

maybe i will be the poster child for my surgeon to show him that you don't necessarily need to have the aggressive physiotherapy right from the first week.

 

[Pheebs52]

@liam2015, it is different here, though the wait can be about 3 months for in demand, top notch surgeons. Once the initial meeting takes place and you decide to go with a particular surgeon, the wait is also generally 2-3 months. I happened to be very lucky in getting my TKR scheduled very quickly, but it was due to a cancellation. If not for that cancellation, I probably wouldn't have had a new knee until August.

The surgeon I ultimately found for the cortisone injection in my hip is the same one I chose for TKR. He was the only one not disturbed about "touching someone else's work." That said, it took months! He's truly one of a kind.

I agree your surgeon has your best interest at heart and wants his work to be successful. As a young one, he probably just needs more experience to realize that not all patients heal in the same time frame. The actual surgery may be *cookie-cutter*, but...the human patients are not. I think you will be able to prove to him there's another, less painful road to recovery. I also think it will be valuable for him to learn that a slow beginning doesn't necessarily translate into a poor outcome. I was a very slow healer with my THR, but in the end, about 14 months post surgery, my hip felt completely *normal.* I just took longer than the average bear.

 

[liam2015]

@Pheebs52 ~ that is amazing about your successful, yet longer than average hip recovery and feeling completely normal after. i'm glad you did find a good surgeon for the cortisone injection that also did your tkr.

 

[Pheebs52]

Yep, it was a bit on the amazing side. Here's what makes it even weirder.....I had a great start! I really did, until about the 12 week point, then everything went south. I developed IT Band Tendonitis and after that, chronic bursitis. I chalk it all up to overly aggressive PT and an unfortunate, ingrained belief on my part at that time that *more exercise is better.* I couldn't have been more wrong, nor could the PT have been. I also had some nerve damage that made certain, typical exercises impossible for months. Most thankfully, the nerves ultimately healed.

I really began to believe I'd never, ever get better and that's a very bad rabbit-hole to go down. I went into that funk because I had been told the usual spiel of 6-12 months for total healing, but it took me 14 months. This sorely tried the patience of my uber-prima donna surgeon. He was a great guy until you fell outside his guidelines for healing; pffft! I don't mean to imply I felt absolutely miserable for 14 months, but I did feel quite miserable for about 6 months, with a lot of improvement by 9 months. I was still using a cane at 9 months. I'd say I was about 70% healed at that point, but I was still **wobbly.* I was also still very hyper-focused on every hip/groin/leg twinge and always conscious of dire possibilities like falling, especially in winter. It took 14 months for me to truly *forget* I had a fake hip and to really have a normal gait and all of my energy back.

 

[flyaway79]

Took me almost 3 months to get a surgical date with my surgeon. That was after two months to get in for a first appointment with him. He is very sought after. The weekend before my surgery I came down with a cold. I hadn't been sick in years and here I was running a fever. I was so afraid they would have to cancel the surgery and since he is so hard to get into I would've had to have gone on a cancellation list. I had already been on a cancellation list try to get in earlier and it never happened. My whole schedule for months was planned around this date. Thank goodness my cold pretty much cleared up and he did the surgery.

Of course the first six or eight weeks after the surgery I was wondering why in the heck I actually did this to myself and maybe it was telling me something