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TKR 8 Month Update

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@referee54, yes my hamstrings are super tight. I bought two 5 lb leg weights last week. I alternate the exercise you describe with sitting up, propping my ankle on a towel roll or another chair, and hanging the weights as tolerated. I'm up to 5 minutes at a time. The heating pad sounds glorious- I will acquire one.

@SuperSnapper, today at PT we did some pilates- basically pushing against spring tension to fire the quads. I have a lovely combination of inhibited quad, tight IT band, and tight hamstrings. My therapist is trying to target the VMO part of my left quad. I am doing easy modified lunges around the house. I must look quite foolish!
 
@Clipless im sure all the work you are putting in will really help your quads. It takes a lot of time. Before I had my microfractures, I didn't do much exercise - too busy teaching full time and looking after a family and as a result my muscles were really weak so I had a lot of intensive physio znd it paid off. Since then I've always exercised regularly and spent 4 months before this surgery doing specific leg exercises to prepare.
You will feel so much stronger afterwards. But I know how hard it is.
I'm looking forwards to going back to the gym in about 6 weeks and the pool too IF my surgeon gives the ok.:swim:
 
I've changed my thread title because quad weakness has been a real problem for me. My first straight leg raise was 21 days post op. It was very painful and initially included lots of lag (lower leg droop). I am now 7 1/2 weeks post op and still having quad insufficiency and lag, though not as bad as before. I slacked off on leg raises for almost two weeks because it was just too painful around my kneecap. I mean seriously painful. Today I started again. It hurt like the dickens at first, with the same annoying lag, but after 30-40 reps (with lots of rest breaks) it seems to be getting easier, less laggy, and less painful.

So, should I have toughed out the pain and done more leg raises early on, or was I appropriate in giving myself time to heal? Will I ever stop lagging? Am I the only one with this problem? Can anyone commiserate, empathize, or identify? Who has a favorite quad-strengthening exercise to share? PT says I need to target my VMO (Vastus Medialis Oblique). Of my exercises, some are easy, some very hard, and some I can only do on their special equipment. Any advice appreciated.

Thanks to everyone in advance!
 
@Clipless Please ask your PT if these are OK for you before you try! I'd hate you to damage anything cos I recommended something. I got these from my physio after microfracture when my quads were weak.

One exercise that's easy to do when you are watching TV etc is hold a ball ( about 12" diameter) between your feet (feet pointing forwards not turned sideways) and slowly raise legs ,still holding the ball, hold for 5 secs and gently lower. You'll gradually be able to get the ball higher so you can get your legs straight still holding on and hold for longer. You need to wear trainers while doing this to get the grip on the ball. I did this for hours!

A harder one:
The other one I practised a lot was laying on my front and raising legs one at a time for about 100 times, then have a quick rest and repeat. After each hundred I'd reach behind hold my foot and see what bend I could get in my knee. The physio used to do it for me at first. You can really feel the quads pulling.
 
@SuperSnapper, the ball exercise- is that done with sitting in a chair, or laying on the couch? And the prone leg raises- straight legs or bent? In other words, do you lift your entire leg or only from the knee down?

Thanks!
 
I think yoga is the answer to everything...lol - I do several exercises specific to the quad, I've linked an article that might be interesting - scroll to the page where you can see the human leg WITH flesh on it - not as creepy as it sounds, there are some bone pictures too. That speaks specifically to the VMO and how you can help support it. Clearly you should discuss with your PT if they might be helpful.

broken link removed: https://www.yogaplustherapies.com/the_great_base_natural-2.pdf
 
Hi @Clipless , did you have a femoral nerve block? I did and it damaged the nerve and gave me the same lag you describe. Post op the lag was 30+degrees. After three year's its still there but reduced to 5-8 degrees.
 
@Campervan, no I did not have the femoral nerve block but I read your thread and noticed the similarities. I'm so sorry this terrible thing happened to you! I inquired about the femoral block before surgery but my OS is very against them. He told me one of his their patients suffered nerve damage eight years ago from a femoral block. The patient suffered "foot drop" (is that the same as lag?) and tremors. He didn't perform the block- an anesthesiologist did, but my OS, along with the other surgeons in his practice, now only allow fem. block as a last resort for pain control. I had spinal block plus general anesthesia.

My quadriceps lag is apparently caused by arthrogenic muscle inhibition- that's when a muscle is confused by a traumatic joint event, e.g. total knee replacement, into assuming it isn't needed anymore. It just goes to sleep. I also have quad atrophy. Getting my quad firing properly is a major goal now, as it affects my gait, my extension, everything. I hope yours continues to improve.
 
Hi @Clipless, I believe footdrop is something else that can happen. I know femoral nerve damage can be severe and function never return. It can be much worse than mine. Generally it doesn't bother me on a normal day, its only when I walk up and down hills that it hurts for a while and then eases off. When walking normally at a regular pace I'm ok but it I try to walk faster then I tend to lock my knee because it won't give me straight leg. So I try to not rush when I'm walking.

Can your leg go passively straight? So if somebody holds your upper leg in one hand and raises you lower leg while you relax all the muscles, will it go straight?

Before the femoral nerve damage was proven by EMG and nerve conduction tests, I too was told something similar to the arthrogenic muscle inhibition that you've been told - I was told the brain needed retraining to fire the muscle and that it had learned not to do that because when it did after the surgery it hurt so it shut down.

I found a cheap Tens machine on TradeMe (NZ equivalent to Ebay) and that helped. Initially we (being me and my physio) couldn't even get the muscle to quiver and it took almost a year to get it to do so.

I believe its remotely possible that femoral nerve damage can occur if the pneumatic tourniquet is on too long.
 
Campervan said:
Can your leg go passively straight? So if somebody holds your upper leg in one hand and raises you lower leg while you relax all the muscles, will it go straight?...

Before the femoral nerve damage was proven by EMG and nerve conduction tests, I too was told something similar to the arthrogenic muscle inhibition that you've been told - I was told the brain needed retraining to fire the muscle and that it had learned not to do that because when it did after the surgery it hurt so it shut down. ....
I believe its remotely possible that femoral nerve damage can occur if the pneumatic tourniquet is on too long.
Click to expand...

Well here's ^ something I'm not thrilled to hear. :( I hate that you've had to go through all of this. It totally sucks and I'm so sorry.

My entire surgery was <2 hours from going in to waking up in recovery, so I hope the tourniquet didn't cause damage. I've got the op report, and I think it gives the times. I had slight bruising on my thigh that was gone in days. How long after surgery were your nerve tests performed? Yes, my leg can go almost straight when held as you describe, or a couple degrees +.

I can get my quad (VMO, specifically) to fire with electrical stimulation and with certain exercises. I totally feel that muscle contract under my hand, and I can hold it, too. After a few quad exercises I even walk better. But then a couple hours later it's back to sleep. There might be an issue with my patella, or some adjacent tendons or soft tissues or something, because when I do leg raises it still hurts there. Maybe scar tissue? Checking just now- I can contract my quad at will to raise my leg, but I don't want to because it hurts. Might that indicate that my femoral nerve is okay?
 
4 weeks out a sleepy quad here too!! Muscle is lost very quickly with inactivity. For every 4-7 days you lose about 10% of your muscle mass. In my case, I had altered the way I walked to relieve pain, I further weakened things. Plus I am still mentally favoring that side due to previous pain. PT has me doing 4" step ups, marches, squats, heel raises and a couple other leg raises.

I really have to concentrate on during the quad, pulling my toes back and lift. I use my gait belt in the hospital to assist with the first few as needed. When you are walking around. Be sure to stand straight, bend your knee and be walking heel to toe. I literally had to relearn a correct gait and not have swagger. It's frustrating, but it will come back! The other thing I have done at PT is e-stim. They put what feels like a TENS unit in my thigh and I do the quad sets when the machine fires. I didn't read through the whole thread, have you had that done?


LTKR November 20, 2014
RTKR sometime in 2015
 
Good to hear from you, @GamsGoneWild ! Yes, I do e-stim (EMS) at PT. I even bought my own unit for home use, but I'm having trouble with it. I think I need bigger/better pads. I think I have all the issues you mentioned, plus a few more.

My house is single story, so I'm going to buy one of those plastic sturdy steps- the kind used in step aerobics class. It sounds like you're doing great with everything! Does your quad still forget sometimes? Mine does, for example when I first wake up in the morning.
 
Hi @Campervan , well I was just ready one study that suggests that some degree of femoral nerve damage after tourniquet use is not uncommon at all- even when the tourniquet is applied for as little as 15 minutes!

I am not going to obsess over the possibility, however I will keep it in mind and talk to my OS if I do not see significant quad improvement by my next appointment (6 weeks from now).
 
According to my operative report the tourniquet was on for an hour. I have no idea what is usual.
 
Very interesting @GamsGoneWild - I thought since I don't always limp...well, the first 20 when I get up from sitting, and pretty much all day after 3 (side note, I might be a tad in denial about the limping thing)

Anyway - I thought my gait was fine until I saw your note and paid attention. I do NOT heel to toe walk because when I do, it's ridiculously painful. Guess I'll have to unlearn that, as well.
 
Hi @Clipless, you are absolutely right not to stress. You are only two months post op. There's lots and lots more healing to happen yet, particularly all the stuff that you can't see. The scar might look healed but that's only the superficial bit.
 
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