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TKR 8 months post op - Life is GOOD!

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Naturelover

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Can someone please change my thread title to Valgus after surgery... May need revision?
Thank you
 
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Naturelover

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10 weeks post op. This morning I went for short walk, 10 minutes down the street and back. I was concentrating on my gait and trying to walk normally. I noticed that while weight bearing on my right leg that my left knee slightly brushes against my new right knee when I stride forward.

I found that the only way I could avoid hitting my knees was to intentionally carry my legs in a wider stance while walking.

Does anyone else have this problem? What can I do to correct this?
 
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@Jockette I saw my surgeon 1/2/20, he was not concerned about my extension or the valgus. He feels my knee will straighten over time. I hope that he is correct, I am trying not to worry about it, the thought of a possible revision is not pleasant. My extension is not good, I believe that I am at +10.

My last PT was January 3rd and I plan to return if I do not make progress on my own. My PT felt we should work towards getting full extension before we started to worry about the valgus angle. My PT had suggested possibly using braces to my OS, such as an extensionator or a dynamic splint, in my last progress report. Stopping PT was my decision because I felt they were too numbers oriented, but my surgeon agreed.

At 10 weeks post op I am/was basically happy with my knees function. I can go up and down stairs, get in and out of my pickup truck and can walk around the house and run errands without pain. I started back with gentle mat pilates and gentle yoga classes and found that I could put weight on my bent knee as long as I have a nice cushion. I continue to ice and elevate.

This week I started taking longer walks around the neighborhood and noticed that while striding forward with my left leg, my left knee brushes against my weight bearing right knee ( My knees don't hit while striding forward with my right leg). This made me worried about the valgus alignment again. Yesterday I made some phone calls to TKR revision specialists and was told to wait a year to schedule an appointment.

I am trying to stay positive but it isn't easy. Thank you for asking Jockette.
 

Jockette

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I think you should go real easy with any efforts to gain ROM. If there is a problem with your leg, trying too hard to correct it with exercises can just make you miserable. Extension often takes quite a while anyway, and walking around doing your daily activities is a good, natural, way to help it.

I have not a good outcome with my partial, either. But even with all my issues (that I did not have before surgery) my ROM has continued to improve past my second year anniversary, as my whole leg has continued to heal and relax. So, don’t worry about yours at this early date.


From what I’ve read about members who have used braces, they are pretty uncomfortable. If indeed your leg is valgus, a brace will not change that.

Try to relax. I’m sorry to say it, but some PTs cause us more worry than help. You are done with PT, with your surgeon’s blessing, so just do what you are doing now on your own. You’re regaining good function. Don’t push things too fast. Always listen to your knee, if something causes pain, back off for a while and try again at a later date.

It really is early in this year long recovery to think about revision. I love to quote Josephine, our Nurse Director, who said, “Allow your knee the privilege of sorting itself out.” Until you are definitely proven otherwise, trust your surgeon. He knows this surgery better than a PT does.
 
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Naturelover

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@Jockette
My left partial had all sorts of pains and issues in its first year. It still bothers me sometimes. In some ways it does not feel normal and my movement is still restricted somewhat. Last year I was able to do "Childs' Pose" in yoga class, I could pretty much stretch down with my butt sitting on my heels, so I eventually achieved great flexion. This June Lefty will be four years old!

I understand time and patience will bring increased healing on my new right knee. Unfortunately I am finding it difficult to believe that in 8 months my valgus misalignment will improve much.

Thank you for your words of wisdom and support.
 

Jockette

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Unfortunately I am finding it difficult to believe that in 8 months my valgus misalignment will improve much.
If it is truly valgus to an inappropriate angle, you’re right, it won’t improve on its own. This is why I believe you should be very gentle with it in this recovery. Don’t try to make it do anything it’s not ready for.

And, just so you know, we have at least one member who did have a revision before the year was up, for a valgus leg. Last time she posted she was still disappointed in the revision, but you might like to read her thread and how and when she got second opinions:
 
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Thank you @Jockette
I just read Hood1980's thread. It is becoming apparent to me that most who have revisions to correct Valgus have poor results.

I am hoping to regain some strength and fitness while simultaneously trying to protect my new knee with non weight bearing exercises.

I plan to contact my surgeon to see about what I can do to ease the foot, ankle and hip pain I am starting to experience.
 

winedunce

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@Jockette I saw my surgeon 1/2/20, he was not concerned about my extension or the valgus. He feels my knee will straighten over time. I hope that he is correct, I am trying not to worry about it, the thought of a possible revision is not pleasant. My extension is not good, I believe that I am at +10.

My last PT was January 3rd and I plan to return if I do not make progress on my own. My PT felt we should work towards getting full extension before we started to worry about the valgus angle. My PT had suggested possibly using braces to my OS, such as an extensionator or a dynamic splint, in my last progress report. Stopping PT was my decision because I felt they were too numbers oriented, but my surgeon agreed.

At 10 weeks post op I am/was basically happy with my knees function. I can go up and down stairs, get in and out of my pickup truck and can walk around the house and run errands without pain. I started back with gentle mat pilates and gentle yoga classes and found that I could put weight on my bent knee as long as I have a nice cushion. I continue to ice and elevate.

This week I started taking longer walks around the neighborhood and noticed that while striding forward with my left leg, my left knee brushes against my weight bearing right knee ( My knees don't hit while striding forward with my right leg). This made me worried about the valgus alignment again. Yesterday I made some phone calls to TKR revision specialists and was told to wait a year to schedule an appointment.

I am trying to stay positive but it isn't easy. Thank you for asking Jockette.
I hope your healing has continued to improve. I had a question for you about yoga. I am enjoying yoga as one of the last forms of exercise I can still do before my TKR in March 2020. I do notice that we spend a lot of time on our knees (cat/cow and other positions). I am wondering if it is possible to kneel after TKR. I have read that people say they can't do it any longer. I didn't know why. I was wondering if it may be due to the risk of breaking your knee cap. Any info you have on this and whether you think I can get back to yoga after TKR would be so helpful. Thanks!
 
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Naturelover

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Hi @winedunce

MY RTKR was 11/08/2019. My surgeon cleared me to do normal activity on 1/02/2020. The following week I went to gentle yoga and mat pilates classes. I used a thick cushion / bolster for kneeling or cat/cow positions. My knee was positioned in front of the bolster so no weight was on my knee joint.
I didn't attempt positions that required more than 100 degrees of flexion. I took it easy and I was a little sore the next day. I believe that I was very fortunate to heal that quickly and was able to go back to the gym for GENTLE exercise ~ 9 weeks post op.

It is uncomfortable to put weight directly on my bent new surgical knee. I won't crawl across my bed on my hands and knees. I think the knee is too sensitive due to all of the scar tissue inside and out.

It took me about 2-3 years after my left partial before I was brave enough to kneel on lefty and to attempt childs' pose. I do use a bolster but I can now put weight directly on my bent left knee.

I am not worried about breaking my knee cap at all. I think after your surgery you should not try to rush your recovery. Follow Bonesmart guidelines and listen to your knee. You will know when you can resume your usual activities. Make sure you get your surgeon's blessing when the time comes.

Good luck to you! Karen
 

winedunce

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Hi @winedunce

MY RTKR was 11/08/2019. My surgeon cleared me to do normal activity on 1/02/2020. The following week I went to gentle yoga and mat pilates classes. I used a thick cushion / bolster for kneeling or cat/cow positions. My knee was positioned in front of the bolster so no weight was on my knee joint.
I didn't attempt positions that required more than 100 degrees of flexion. I took it easy and I was a little sore the next day. I believe that I was very fortunate to heal that quickly and was able to go back to the gym for GENTLE exercise ~ 9 weeks post op.

It is uncomfortable to put weight directly on my bent new surgical knee. I won't crawl across my bed on my hands and knees. I think the knee is too sensitive due to all of the scar tissue inside and out.

It took me about 2-3 years after my left partial before I was brave enough to kneel on lefty and to attempt childs' pose. I do use a bolster but I can now put weight directly on my bent left knee.

I am not worried about breaking my knee cap at all. I think after your surgery you should not try to rush your recovery. Follow Bonesmart guidelines and listen to your knee. You will know when you can resume your usual activities. Make sure you get your surgeon's blessing when the time comes.

Good luck to you! Karen
Thank you so much for this! I will be very patient with recovery. I subscribe to the Bonesmart way. I have done that with my last three knee surgeries and it has been very positive. Good to know about the scar tissue on the knee cap. I hadn't thought of that. I wish I could find a surgeon in my network and area who does the minimally invasive surgery with robotic assist. I have a friend who had that done and she has a smaller scar along the side of her knee like a smiley face so she doesn't have the scar tissue on the knee cap.
 

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I won't crawl across my bed on my hands and knees. I think the knee is too sensitive due to all of the scar tissue inside and out.
You don't have adhesions, you have the normal scaring it takes to close us your tissues. Yes, the number-obsessed PTs will rattle on about it as if the big. bad "scar tissue" is just sitting there, waiting to pounce if you don't do enough exercise.

Actually, it's quite the reverse. The infamous scar tissue (which is more correctly called adhesions) is very rare, and one of the easiest ways to develop it is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions.

This article explains the difference between scar tissue and adhesions:
MUA (Manipulation under Anaesthetic) and Adhesions

You need normal scar tissue. That's what holds your incision together, and it's part of the normal healing process. Without it, you'd always have an open wound.
 

Jockette

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I think the knee is too sensitive due to all of the scar tissue inside and out.
Scar tissue has gotten a really bad name over time. It is blamed for just about everything bad in this recovery. Sistersinhim has explained it well.

What you are feeling is soft tissue that was wounded in the course of the major surgical assault to your leg, and it takes a long time to heal.


I read this that one of our other advisors wrote:

“Many members think PT is needed to alleviate tightness. Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.”
 
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Naturelover

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@winedunce
I am thinking I was not clear in explaining to you why I won't crawl around on my hands and knees. It isn't necessarily the scar itself that is too sensitive for direct pressure....

I think Jockette's response above, regarding all of the soft tissue that was damaged during the surgery
that takes time to heal, is why folks on this forum avoid kneeling following their knee surgeries.

Also, neither of the incisions from my knee surgeries were centered directly over my kneecap. They are both located more towards the inside each knee.

I hope that my explanations make sense.
Karen
 
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Just a brief update regarding my ankle pain and valgus alignment.

I saw my OS yesterday. He took new x-rays and estimated the valgus to be 6 degrees. He checked out my pre-surgical x-rays and calculated that I was 5 degrees varus.

Even though there is an 11 degree difference in alignment between my pre and post TKR, he feels that eventually my body will heal and adjust over time so that my leg should not be painful.

I forgot my to ask my OS "what alignment he was actually shooting for"? As well as what he considers "normal" alignment for women.

He told me to continue to increase the distance that I walk and to use my knee. He wants me to return in 2-3 months to check on my progress.

I will try to remain cautiously optimistic about my ability to walk without pain in the near future.
 

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I think Jockette's response above, regarding all of the soft tissue that was damaged during the surgery
that takes time to heal, is why folks on this forum avoid kneeling following their knee surgeries.
It's that all right, but it's not only that.

Many people have the damaged cartilage removed from the back of their kneecaps and this is then replaced by a plastic button. While it does a good job, that plastic button is harder than the cartilage it replaced and that can account for much of the uncomfortable feeling when you kneel.

I can kneel, but I dislike the feeling, so I don't do it often. I'm glad I can do it, though, because once I had to kneel on my driveway in the middle of the night, to turn off the main water supply to my house - I had a major leak and my kitchen was flooding.
 
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Naturelover

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Can someone please change my thread title to 8 months post op Life is GOOD
 

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