TKR 60 degrees ROM at 2 weeks. No progress at all :-( <

[bertschb]

I'm totally fine with a slow recovery. What scared the beans out of me was thinking I had scar tissue built up because I did something wrong during the first 10 days after surgery and I would need a manipulation as a result. As long as I don't need a manipulation, I'm a happy camper (although I'm way past cabin fever at this point!).

I do have access to fitness equipment but I think it's way too early for that.

 

[Roy Gardiner]

I do have access to fitness equipment but I think it's way too early for that.

 

[Clipless]

Welcome bertschb, and congratulations on your new knee!

Both my knees are replaced and I am a mountain biker, too. You will ride again and ride well, so don't despair, okay? TKR recovery takes a long time. My LTKR was only 70° at three weeks post op and now, two years later, my flexion is 125-130°. I did not require MUA. My RTKR was installed one year after the LTKR and progressed faster for whatever reason, however they are both about equal now (I found a goniometer at work and measured them myself). I had a rental cpm machine and home PT for my LTKR, but eschewed all of that for my RTKR and enjoyed a faster and more comfortable recovery. After both surgeries I was back on the bike riding flat, easy terrain by about 12 weeks post op. Progress after that was gradual but steady. Thanks to my bad knees I had not been physically able to climb out of the saddle for at least a decade, and now I can! I can also hike as far as I want and I have just started trail running again. I have not been able to run for 15+ years!!!

When you are ready to ride outside I will have a few general cycling and mtb-specific tips for you. Did you know we have a Bonesmart cycling club and a Strava club, too? Find us in the Social Forum. Keep us posted on your progress!

 

[bertschb]

Thanks for the encouraging words Diana. I'm REALLY looking forward to long hikes again. It's been a long time since I've been able to do that.

-Brian

 

[Jamie]

So sorry all this is making you anxious. But you're doing the right things and you've received all good advice so far. It's difficult to accept that youth and conditioning don't always make a difference in TKR recovery. Our "logic" says it should, but knees have other ideas. Actually, it's more of a factor of what your surgeon did while he was in your knee. The more time spent in surgery, the more soft tissues and bone that are "messed with" (and I'm using that phrase lightly because there is significant tissue trauma!), and the condition of your knee to start with all are factors that will outweigh your youth or fitness. Your knee is in charge here and you just get to go along for the ride.

One thing you might consider is that pain, inflammation and swelling go hand in hand. If you do have a rather high tolerance to pain, it still might be a good idea for you to take 1000mg of Tylenol every 6 hours (no more than 4000mg in any 24 hour period) on a schedule to be sure you are giving your knee the best chance possible to reduce that swelling. That said, it is normal to have swelling at your early stage in recovery, so please don't assume what you're experiencing is out of the norm.

You are right that it is way, way too early for any fitness equipment. But an exercise bike offers something else for the TKR recoveree. You put the seat up high enough so that you can rock the pedals back and forth. This gentle motion allows you to gently stretch your knee. This is the way most people begin and one day they find they can do a full rotation (usually on the backwards rock). The key to using a stationary bicycle is to not overdo it because it is a fairly gentle movement. Start at 3 minutes twice a day. Add a minute every third day (if you're not getting any pain or swelling afterwards) until you get to 10 minutes twice a day. Later in recovery when I would wake up in the night with stiffness, 5 minutes on the bike would relax my knee enough so I could sleep.

One other suggestion is to ice all through the night too....front AND back of your knee. Because you don't move around a lot when sleeping, your knee can stiffen up and swell a little. You might not even see swelling because the knee compartment itself is very compact. It doesn't take much fluid in there to tighten your knee and inhibit your ROM.

Bottom line is that you are fine. This is early. It's way too early to think about an MUA. Try to relax and talk gently to that knee of yours. It's doing its best to heal for you.

 

[bertschb]

Thanks Jamie

One of the strangest things I've learned through this process is my apparent high tolerance of pain. All my life I thought I had a low tolerance for pain even though I really had nothing to compare to. But after watching a few minutes of a video my surgeon posted on Youtube of TKR, I knew this surgery had to be super painful. TKR surgery is one of the most barbaric things I've ever witnessed. Even so, I've just never had much pain at all. I did take meds the first week but even then there wasn't much pain.

My surgery took less than an hour. My understanding is my surgeon is one of the faster people out there and he does this to reduce the chances of infection. The less time the wound is open, the less likely we are to get an infection. But, with that speed comes a lack of gentleness which I would think would translate to more post surgical pain.

For the first 10 days or so I was sleeping with ice but I haven't done that since. I'll resume that this evening. The ice machine I'm using will only stay cold for 4-5 hours but that's better than nothing. It sounds like I can't have too much ice so thanks for that advice. I will also start taking a little bit of Tylenol throughout the day even though there is no pain. Certainly can't hurt as long as I stay under 4,000mg.

-Brian

 

[KarriB]

I second Jamie's comment about a bike. At first I could only rock the pedals back and forth, but about a week after starting that I lifted my hip a bit and VOILA! I got a full rotation! I hadn't been allowed to bend my TKR and was in an imbolizer for a month, so getting a full rotation was exciting and helped to loosen my knee.

 

[little red canoe]

It might be a little early for you but I do five minutes three times a day on a pedal exerciser . I sit in a chair and the exerciser keeps my knee more nimble.. They are quite inexpensive. As your ROM improves you can move it closer to you.

 

[Clipless]

I agree with everyone on exercise bikes. Any sturdy stationary bike will work. Some recovering folks like those little peddlers, but I personally needed to feel like I was really cycling. I bought one of the original spinner pro bikes years ago when my boys were little and I couldn't get out and ride. That spin bike was the first thing I aspired to after each TKR. Like Jamie and others I could only rock the pedals back and forth for a couple of weeks at first (after my first TKR), and then finally got them all the way 'round. After my second TKR I was pedaling well on post op day 4, and rather dumbfounded that I could. My bend is now equally good in both knees.

Might I suggest keeping several large flexible gel-packs in your freezer so you can easily swap them out as they warm up? For some this beats fussing with an ice machine, though ice machines are really good, too.

 

[bertschb]

We do have several gel packs that we keep in the freezer and use when the ice machine is too cumbersome. My wife is going to go to the thrift store in the next week to look for a pedal exerciser and I can also go to the fitness center nearby (2 minute drive) which has equipment and a pool.

 

[little red canoe]

For sure the peddler is no substitute for a real gym bike but using it several times during the day at home seems to keep me from stiffening up. We do use a gym too but its a half hour drive each way..
Gel packs are a great idea.. will look at the dollar store

 

[KarriB]

How lucky to be close to a fitness center with a pool no less! I found being in the water helpful later in my recovery, although you must be careful as it's easy to over do it in the water.

 

[Josephine]

1- Current pain level - 1

Well, I expect you failed to include these manifestations of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness. They all count too.

2- I was prescribed 1-2 5mg Oxycodone every 4 hours as needed. I stopped taking them after the first week because there is no pain.

See above!

3- Swelling is moderate per the examples you posted.

Exactly - that equates with at least 2-3 points on the pain score.

4- ROM was measured at 65 and 10 today when PT started.

And this was due to the swelling you have. Swelling isn't always external as shown in those pictures. Sometimes it's internal and the sign of it is that your leg feels solid. So does it?

5- My knee is on ice about 85% of the time I'm awake.
6- My knee is elevated about 80% of the day. I sit/lay in bed the rest of the time to help straighten my leg and improve extension.

"on ice" makes it sound like a fish! LOL! But you shouldn't elevate with your knee totally straight. Did you read the articles Roy left you - specially this one Elevation is the key? If you keep your leg straight all the time, it increases the swelling and therefore decreases the ROM. In this case, it increases the swelling at the back of your knee which affects the extension. It's perfectly okay to rest with a slight and comfortable bend in your leg. Legs aren't actually designed to be kept totally straight all the time.

7- Zero activity. My amazing wife does everything for me.

Lucky you!

My comments in bold
Home PT exercises done twice daily as follows - do them once a day and none at all at the weekend
- Assisted leg lift while on my back (10 reps) - do you mean with a strap or someone helps you? A strap is okay but be gentle! And I suggest 5 lifts is more than enough.
- Side leg lifts held for 5 seconds (10 reps for each side) - this exercise is not designed for knees! I suggest you stop doing it
- Leg lifts while on stomach held for 5 seconds (10 reps) - don't see the point of these either.
- Push knee down while sitting on floor (3 sets of 10) - that's far too many - much better that you do 3 about 3/4 times a day only. More does not get you there. And actually walking is the best activity for extension.
He did bend my knee quite a bit for about a minute or so. It wasn't painful but it was pretty uncomfortable - given your high tolerance for pain, I would say that you don't permit this. You need to read this BoneSmart philosophy for sensible post op therapy.
Please note the ones I had crossed out.

I think my problem is I came into this expecting to be one of the people with better than average results, not way worse than average. I was riding my mountain bike 100 miles a week right up until the surgery. Up until the last year I was hiking, biking, kayaking, skiing, snowmobiling, scuba diving - you name it. I'm in decent shape and just did not expect to have such horrible ROM after the surgery.

How fit and active you were beforehand is largely irrelevant this side of surgery. Your new knee doesn't know about that and only knows that it HURTS!

TKR surgery is one of the most barbaric things I've ever witnessed. Even so, I've just never had much pain at all. My surgery took less than an hour. My understanding is my surgeon is one of the faster people out there and he does this to reduce the chances of infection. The less time the wound is open, the less likely we are to get an infection. But, with that speed comes a lack of gentleness which I would think would translate to more post surgical pain.

The other and less bragged about consequence is that the shorter the surgery time, the less time he has to handle and pull the tissues around. It's my belief that this accounts for a considerable amount of post-op pain and swelling. I do know that the longer the surgery lasts, the more pain the patient has. Plus, he might have used a modern technique of injecting local anaesthetic into the joint jest before he closes the wound. My surgeon took on this practice just before I had my second knee done and I was totally amazed at the very small amount of pain I had. He also admonishes his assistants if they are too heavy handed with the retractors which is another favourable factor.

But over and above all this, I do think that if you cut back as we've suggested and allow your knee time to heal and recover, you will find your ROM improves in time and by the end of 12-16 weeks, I bet it will be nearly as good as you want it to be.

 

[bertschb]

Thanks for the lengthy reply Josephine! I really appreciate you taking the time to do that!

You mention soreness, burning, stabbing, throbbing, aching, swelling and stiffness as signs of pain. I do have swelling and stiffness but I don't have burning, stabbing, throbbing or aching. I've never considered stiffness to be painful which is why I said my pain level is a 1. If I include stiffness as pain, my "pain" (stiffness) level would probably be a 5 or 6 depending on the time of day.

I absolutely agree that my swelling is what is restricting ROM. My knee is bent the majority of the time while on ice. I do try to sit in bed for a short time at least once a day to kind of stretch the muscles in the back of my leg. The assisted leg lift is where my wife helps me lift my leg off the bed while I'm laying on my back. My muscles are so weak that I can't really lift it by myself which I find astounding.

Because of all the great feedback on this forum I'm far more encouraged about a good recovery than I was initially. I think swelling is what is holding back my ROM more than anything. I had meniscus surgery a year ago and my knee has been swollen ever since. I even had fluid drained twice but that only helped for about 24 hours each time. My body seems to like to push fluid to my knee and I think it works overtime doing it! Once the swelling goes down things should improve dramatically.

I'm not worried about my ROM any more! I'm just going to kick back and relax and let my knee heal in whatever time frame it needs. Thank goodness I'm retired which makes kicking back and relaxing pretty easy.

 

[Celle]

I'm glad you're going to try taking it easy, as Josephine advised.
There really is no need to rush to get results.

Here in New Zealand, we used to have a TV advertisement about making tasty cheese. The punch line was "Good things take time." That is so true of recovery from a knee replacement. It takes time, and patience, but it will happen.

 

[little red canoe]

Bertschb... I don't think your muscles are weak in the case of straight leg lifts. They are healing and fibers swollen. After the swelling subsides you will be able to do plenty of lifts. I had trouble like you for the first couple of weeks and now I can do so many whole leg lifts and lower leg lifts unassisted without pain that exercise is not pointless. It took about four weeks total.
I hear you about the unwanted fluid.. It will go away.. I thought mine was a squatter in the knee room and one day it just left a couple of days ago.. I go to PT tomorrow and expect that with no one pushing I can get to 120

 

[Josephine]

You mention soreness, burning, stabbing, throbbing, aching, swelling and stiffness as signs of pain. I do have swelling and stiffness but I don't have burning, stabbing, throbbing or aching. I've never considered stiffness to be painful which is why I said my pain level is a 1. If I include stiffness as pain, my "pain" (stiffness) level would probably be a 5 or 6 depending on the time of day.

It's not required that you have all these types of pain! It's just saying that each of these are types of pain and should be counted in when declaring a pain score. And while you may not feel like your stiffness is painful in the general sense of it, it has the effect of pain in that it impedes your ROM. And so now it's included, your score is a much more realistic 6 which needs to be medicated. Go read the recovery articles again - it's all in them.

The assisted leg lift is where my wife helps me lift my leg off the bed while I'm laying on my back.

Oh I see! That's okay then!

My muscles are so weak that I can't really lift it by myself which I find astounding.

Actually your muscles aren't weak, they are injured. Quite a different thing and perfectly normal at only 9 days out. Plus you might have some Tourniquet pain which will make things worse.

My body seems to like to push fluid to my knee and I think it works overtime doing it!

Your logic might tell you that but what is really happening is that your leg is responding to the trauma and pain of the surgery. It does this by swelling and swelling is a form of fluid in the tissues. If you've ever sprained your ankle, you will know how readily it swells - same thing. But that's why you need to elevate and ice and these are both excellent treatments for both.

But I am delighted you're no longer fretting about any of this. It will settle down so long as you don't anger it more!

 

[bertschb]

So here's an update-

My surgery was three weeks ago today. Thanks to the wonderful people on this forum I'm no longer concerned about the long term prospects of my recovery. However, because of the way my knee is healing (slowly!), I'm resolved to a lengthy recovery period. My ROM has improved slightly in the last week. I was around 60 for the first 10 days after surgery. I'm now in the mid 70's and when I push it, I can get to 80.

I'm committed to doing PT until the end of this month mainly for the benefit of my surgeon. But I don't have any plans beyond that as I can now clearly see they are all about numbers (my PT measured my ROM multiple times today at our session) and I can do all of the exercises/massaging they recommend at home by myself.

Both my original and fill in PT people have talked about the possibility of an MUA. I told them both it was highly unlikely I would agree to that procedure and wouldn't even consider it until at least MANY months had passed without any real improvement in ROM.

My PT also mentioned going to acupuncture to help reduce swelling. Any thoughts on this? I'm thinking my surgeon may not want to risk infection.

At this point, I'm fine with gaining a couple of degrees of ROM each week. As long as I don't go backwards, I'm fine. I am finding it easier to get up and move around the house. I'm sleeping fine. Pain is fine. I'm not gaining any weight even though I spend 23.5 hours a day sitting in a chair or sleeping. So, I'll just continue to follow the BoneSmart Mantra and look forward to a strong healthy knee next summer.

 

[referee54]

I find your attitude refreshing and very healthy!!

At this point, I'm fine with gaining a couple of degrees of ROM each week. As long as I don't go backwards, I'm fine.

My BTKR recovery was really, really long. I would ask my PT when I would "get there"---meaning fully recovered----and he would smile and say that I would, but it was up to my knees, not me, nor him. You are doing fine!

I'm now in the mid 70's and when I push it, I can get to 80.

Take it easy, ice, rest, and elevate, and gently stretch---you will gain ROM in tiny increments, but that adds up to a big win when you are fully recovered!

I'm committed to doing PT until the end of this month mainly for the benefit of my surgeon. But I don't have any plans beyond that as I can now clearly see they are all about numbers (my PT measured my ROM multiple times today at our session) and I can do all of the exercises/messaging they recommend at home by myself.

There are quite a few of our members here that did no PT at all and got along just fine.

Both my original and fill in PT people have talked about the possibility of an MUA.

It is much, much, much too early to even think of that---and you are right, it is not up to them; it is up to you!

 

[Josephine]

I'm now in the mid 70's and when I push it, I can get to 80.

No, don't push. The number you can get to without pushing is the only one that counts.

I'm committed to doing PT until the end of this month mainly for the benefit of my surgeon. I can do all of the exercises/massaging they recommend at home by myself.

WEll, you know what? You don't have to do any of it. It all contributes to the swelling which is what is holding your ROM back. Leave it alone - no exercising, no massaging - and your ROM will return. It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all 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. Exercise as in strength training is counter-productive and does more harm than good. Normal activity is the key to success.

My PT also mentioned going to acupuncture to help reduce swelling. Any thoughts on this?

Don't waste your time/money. It's more of a placebo than anything.