TKR 8 weeks post TKR

[Steveg63]

Morning/afternoon/evening all.
I am 8 weeks post surgery, date of TKR was 22/02/2024.
I am a little behind where I thought I would be, difficult to judge as nothing to compare it too. However here we go, would be good to get some feedback.
Been having 1x pt session per week for 30mins since 2 week post surgery.
Exercise at home
Use a treadmill to walk 1 mile a day (easier than walking in the constant rain we have in the UK)
Still have the tight band under my knee
Some swelling to the outside of my knee.
Elevate and ice the knee 3 to 4 times a day, usually after the exercises or my walk.
I can walk around house without any walking aids but this reduces as the day wears on.
Sleep has returned to something normal but still tired during the day.
Reduced my pain meds to over the counter pain relief.
95/0 ROM.
Saw my consultant last week and he is "threatening" manual manipulation if my rom does not improve over the next 5 weeks.
I have read everywhere that we all recovery at different rates, however its been quite frustrating with the lack of progress I have made.
There seems a lot of other sites that state you must be at 110plus at week 8. Walk 3x30mins a day unaided, back working and driving!
Well I am not and starting to feel a little despondent.
Well that's it of my chest, back to the exercise.

 

[Layla]

Hello and Welcome to BoneSmart!
Please identify which knee was replaced so we're able to add that info to your signature.
You will find numerous threads here to compare your recovery too, although we advise against it only because no two recoveries are alike, even with the same person.

You can ice and elevate more than three times per day, if interested in doing so.
The tight band sensation, it is caused by scar tissue, but not the adhesions type of scar tissue.
During surgery your OS undercuts the skin and superficial structures from the center, to each side of the knee, to obtain access all round the bones. While healing, those flaps re-attach themselves to the main body of the leg, creating a thin layer of scar tissue across the front and sides of the knee. Scar tissue isn't as flexible as normal tissue so it feels like a clamp across the knee if there is any swelling and later during normal activity.

In time it gradually reduces in size and thickness until it reaches a point where it's not substantial enough to cause this sensation, same goes for the incisional scar in the skin. This can take several months to dissipate completely and often excess walking or standing can make it worse. This differs from person to person.

Please don't be intimidated by the threat of MUA. No on can force you to undergo the procedure.

I will leave a couple of accounts below the Recovery Guidelines of a few members in regard to ROM.
Thanks for joining us!

 

[Layla]

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

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.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

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
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?

Nutrition is of paramount importance. Available here are dietary tips, nutrition basics and additional food supplements. These articles are both general advice on food and specific guidelines aimed at people both pre- and post-surgery.

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.

 

[Layla]

Member JusticeRiders post -

"I just want to add, for all those coming along, a note on ROM. I want to share this because nearly all of us have a tremendous amount pressure put on us to increase our ROM by certain deadlines, or else.

Mine has been extremely slow coming. First I had to wait out the swelling, which in my case took more than 5 months. Yes, months. At that point I began to see real progress. It has continued to this day. I have seen improvement in the last 2 weeks. It’s still going. A this point I think the limiting factor is tight muscles, ligaments, and tendons from 3 yrs of very limited ROM and actually about 25 yrs of somewhat limited ROM. Those tissues are slowly stretching.

I have had to be willing to let my flexion improve at a glacial pace, be very patient, and tune out the dire warnings of my surgeon, PA, previous PT, and some well meaning acquaintances. I refused painful PT and refused a MUA. I have absolutely no regrets. I know my body, and I believe those things would have caused a domino effect of swelling and pain that may have derailed my recovery long term and even possibly have torn soft tissue, etc. I now know I have the added challenges of hypermobility and an immune condition that causes an inflammatory reaction. I think a MUA would have been very harmful to me.

Instead of forcing it, I have relied on weekly massage and using my stationary bike as a stretching aid every single day. I have been very active, but I have ramped up really, really gradually. I have not measured my flexion, because honestly I feel almost a PTSD type of reaction around it. All I care about is function and what I can do. My knee is very functional now, and still improving. I love my new knee. I’m glad I let it heal on its own timeline even though it was so much longer than everyone (most of all me!) would have liked."

 

[Layla]

VolLady's post -

"I want to tell everyone that has went though TKR that it is a long journey to heal. I am going this spring to have my other knee replaced.

Please do not get discouraged and I know you will because I did with my first one and cried more than I had in a life time. Scared mostly.... Surgeons will not tell you everything that you will experience during your healing. It took me 7 months actually to feel more normal but not 100%.

For the ROM I only got to 112 at 4 months and still cannot bend it all the way back to reach 130. But I can drive, sit at a table, put my shoes and clothes on great without a ROM of 130 or 120. There is no swelling at all at 8 months but I still have some stiffness at times but I deal with it and walk. I also still ride my bike with no trouble.

I am telling everyone this because your body will heal without PT and pushing your limit beyond to the point there is more swelling and pain. I have decided when I have my other knee fixed this spring, that I will do my own PT since I have all the equipment and items that they use anyway.

I had a MUA at almost 6 wks., and regretted it from day one. Simply because it did not help me anymore with my ROM but it did set me back on healing. The swelling was awful. I will not have another MUA even if my ROM was 95 at the time.

I will go in with open eyes on this other knee comparing on what I went though with the first one. So, with all that said, I wish everyone a happy healing and let your body decide with healing than someone trying to push you until you scream with pain. Also don't worry about the ROM, it will come -- it might take a year or more, but it will come. I am 67 years old and I don't expect to get past 120, but I do what I want to do at 67. Oh! and I can even bend down with the knee need to kneel on it..... Best wishes everyone!"

 

[JanD041]

Hi there, I am in the UK and will be 9 weeks post right TKR on Thursday this week. Please do not dispair, where you are at sounds very similar to me. I think here in the UK we are being offered less physio therapy than in the past due to the underfunded NHS. I know when I had my hips replaced I was offered weekly therapy sessions plus free pool and gym use for 6 months. None of that this time. I have seen a physio in person twice plus three phone calls. What I have found out has really been from YouTube and Google. I wish I had found this forum earlier as on advice I really pushed myself and it was very painful, I have always disliked the phrase "no pain, no gain" and felt as though I was going against my best instincts. This Forum was a turning point at about 6 weeks I finally relaxed and listened to my body and did only what I felt was comfortable at any given time. I no longer care if I am where the advice says I should be and ironically have come on, not exactly 'leaps and bounds' but certainly a long way since. I may be wrong but I think after the initial post op period of about four weeks we are all pretty similar in our response to the surgery, barring any setbacks of course, from probably six weeks a lot depends on how your fitness was before surgery. For example, I had walked with a limp and a cane for a good couple of years previously so now correcting that is my main and most difficult goal. But we are all so very different you really can't compare. Good luck to you and I hope everything goes smoothly and safely hereonin. X

 

[Steveg63]

Thank you for your reply. I paid privately for my surgery and physio, was told I would not be put on the NHS waiting list due to my age and the damage was not servere enough.
Suffered with bone on bone for number of years!
It's difficult to appreciate what's involved in the surgery and the recovery, find it hard to believe that I am still so tired.
Thanks again for your reply.

 

[JanD041]

Yes the tiredness really is a shocker. Even if you had a reasonable night's sleep the most ordinary things can wear you out. I did my exercises this morning then walked round the park using only one crutch for the first time. I have been shattered ever since!! I still sometimes have a little nap in the afternoon. No way will I be going back to my physically demanding job anytime soon! Slowly, slowly, catchee monkey so they say! Good luck with everything x

 

[mendogal]

Thank you for your reply. I paid privately for my surgery and physio, was told I would not be put on the NHS waiting list due to my age and the damage was not servere enough.
Suffered with bone on bone for number of years!
It's difficult to appreciate what's involved in the surgery and the recovery, find it hard to believe that I am still so tired.
Thanks again for your reply.

On a cellular level, all our energy after major surgery is going into repair. For survival reasons, our body just doesn't prioritize what we think we want to do!

Or as staffer Roy Gardiner puts it...
"When you are icing and elevating and watching telly you are not 'dossing around' you are 'engaging a carefully considered proactively designed heuristically programmed dynamically structured recovery programme'."

 

[Steveg63]

Had my 1st massage today, walked to the car and put dinner on when home, absolutely wiped now...it's taking some getting used to.
Elevate, Ice, dinner then bed...living the high life

 

[mendogal]

Oh I remember my first massages after each knee replacement (upper floor of a Victorian house, so got to practice sequential stair climbing and descending too!). What a joy to have some leg, hip, and sacral releases!!

 

[JanD041]

I've been having to do my own massage but even that is better than nothing! Sounds wonderful! X

 

[Steveg63]

Bought a cheap massage gun of Amazon, £15, worth its weight in gold.

 

[Healing]

Hi! I had my 2nd knee surgery 1/3/24. Had lots of pain, very little sleep and was drained for many weeks. At between 7 and 8 weeks I really turned the corner. Slept better and less pain and swelling so rom started to slowly improve. I'm at about 115 now and feel that is good for me. My other knee about 118 and I am happy with this. Your rom will continue to improve with time. Good luck with your recovery!!

 

[Steveg63]

Thanks for sharing.

 

[Jsin182]

8 weeks out BTKR, doing excellent; Sorry to brag but I ignored all the advice and really pushed the physical therapy hard, I'm a former endurance athlete. Totally mobile and functioning; walking 2+- miles a day, preforming most tasks and able to kneel on both knees. Replaced brakes and changed the oil on the car today as weel as other chores. ROM is 135 on both and 2 and 3 on extension. Been fighting with the extension for weeks. PT 3 x per week plus 3x per day at home.
All sorts of stiffness, aches and pains typically in calf's and behind knees causing the need for an occasional Tylenol at night when I overdo. Tight bands have moved from above my knee to across the knee but much lesser. I agree the fatigue is unexpected, bothersome and sleeping is usually an issue. WiIl start riding the bicycle trainer this week to work on endurance and strength.

 

[Steveg63]

Wow, well done if I was where you are I would be bragging.

 

[ladyj]

I think you are overdoing it.
Stop worrying about physio. I am at 7 weeks post op. My surgeon and my physio both think I am doing splendidly.
I am doing the exercises very gently and a few at a time.
My knee is still a little swollen, and I am often completely exhausted. My very experienced surgeon tells me this is completely normal.
I am doing some household tasks, and try to walk a little further each day. Metres not miles.
There will be a time for harder work, stretches and exercises, but it is not yet.

 

[Layla]

Elevate, Ice, dinner then bed...living the high life

A healthy sense of humor is always a good sign to me.
Cheers to regular relaxing massages and more energy in the weeks to come. You're on your way!

 

[Steveg63]

Hello and Welcome to BoneSmart!
Please identify which knee was replaced so we're able to add that info to your signature.
You will find numerous threads here to compare your recovery too, although we advise against it only because no two recoveries are alike, even with the same person.

You can ice and elevate more than three times per day, if interested in doing so.
The tight band sensation, it is caused by scar tissue, but not the adhesions type of scar tissue.
During surgery your OS undercuts the skin and superficial structures from the center, to each side of the knee, to obtain access all round the bones. While healing, those flaps re-attach themselves to the main body of the leg, creating a thin layer of scar tissue across the front and sides of the knee. Scar tissue isn't as flexible as normal tissue so it feels like a clamp across the knee if there is any swelling and later during normal activity.

In time it gradually reduces in size and thickness until it reaches a point where it's not substantial enough to cause this sensation, same goes for the incisional scar in the skin. This can take several months to dissipate completely and often excess walking or standing can make it worse. This differs from person to person.

Please don't be intimidated by the threat of MUA. No on can force you to undergo the procedure.

I will leave a couple of accounts below the Recovery Guidelines of a few members in regard to ROM.
Thanks for joining us!

Hi, was my right knee, tkr plus "trimming" of the patella as the surgeon couldn't get back due to the length of time it had been displaced.