TKR A new chapter begins - 16 Dec 2014

[treypops]

@lunula I don't know that I would be concerned unless your OS is concerned. My flexion at my session dropped almost ten degrees from the last one, so that number seems like it's pretty arbitrary sometimes. I have also discovered that my hamstrings are the primary flexion limiter for me, and I get much better results if I stretch them real good prior to pt. In fact, I will get into my cpm, set as high as I can stand it comfortably for about two hours, then ice, then spend about 30 mins stretching hamstrings prior to pt. Feel free to steal my little routine and see if it helps improve your rom and extension.

 

[kneeper]

I found stretching helpful too. I didn't have extension issues, but I'd say 85 flexion isn't bad for your stage. Sometimes we hit temporary plateaus.

 

[Legin]

We all seem.to.hit that infernal wall. I.to found stretches to be sooo helpful. I.didn't.realise at first.but at.the.sink washing.up I was sliding leg back th stretch calf. These temporary set back.are just that temporary.
Good luck.and.keep smiling

Legin THR Sep 14

 

[Minnie's knees]

@lunula I think 85 ° at this point is good. It's only been a few weeks since your surgery. Sometimes it may stall for a little while but keep doing your exercises and stretches and you will get there. TKR recovery takes patience and for some more than others. At 3 months my ROM is only 85° even after an mua (due to locking and pain from walking like frakenstine). I have other health issues which have affected my recovery but overall it is slowly improving each week and you will to. Best wishes on your continued recovery.

 

[lunula]

Thanks so much for your replies! I am definitely stretching more now. I no longer have the CPM, but I think I am okay without. My PT showed a wonderful gentle bend/straighten exercise using an exercise ball. I got one for Christmas to use as an office chair, so it is the perfect size. I just sit on it while watching tv and gently move forward & backward - I do this for a good 20 minutes and it's great!

I was looking up new stretches online the other day because I am experiencing some pain on the side of my knee (ITB I believe is causing pain) and I found something from the University of Connecticut about TKR. It read that by day 7 your knee should be totally flat and that by day 14, if you hadn't reached full flexion, they would do MUA. I was seriously horrified. I wish I could find it now, can't remember what search I did to find it, but I was going to write them a note and tell them how harmful that advice is. At day 14, I was barely getting my pain under control. :(

 

[lunula]

Not great news today - my PT feels pretty strongly that my lack of bend is due to adhesions, not swelling. Made an appointment with my OS for next Thursday to discuss MUA. I am going to continue my PT and maybe I will have a break-thru - but she feels the same "frozen" spot that I do - there is just no give at all. I also have a lit of scar tissue around my incision, it is very lumpy. Trying to massage and break that up, but ouch!

5 weeks out today and my flex is still 85. Bummer.

 

[Celle]

@lunula
Please let us know what your surgeon says.

It's only just over a month since your surgery and I think that the lumpiness around your scar is just part of normal healing. There's no need to try and break it up. Just wait and see and I think you'll find that it gradually goes away without any intervention. Certainly, don't go trying to break it up if it hurts.

 

[kneeper]

I agree with Celle that it may be too early to worry about "lumpy" areas along the scar. I think they can smooth out as you heal. I had a "hard" area above my knee cap that diminished as I healed.

 

[lunula]

Hi all - nothing new to update, really. I had PT last Friday and my session was with the PT assistant. She measured my flexion at 100, which I flat-out know is incorrect. I have a feeling my hip was helping too much, but she didn't want to re-measure - guess she wanted to add that nice update in my file. With a lot of assistance, I did get my extension down to 4 - I have been doing a lot of stretching, so it seems to help.

I have PT again tomorrow and I will ask that she measures while I am on my stomach, that is how the "main" PT was measuring as she explained your hips cannot really help when she takes the measurement that way. I have been sitting on the bed with my leg dangling, and though it might be 90, it is definitely not bending past that.

I see my OS on Thursday to see what he thinks. I am supposed to go back to work on 5 February, and pain-wise, I think I am fine. I am down to 2 Oxycodone per day (morning and early evening) and 1 Oxycontin before bed to help get me through the night. That prescription is done in 4 days and I won't be refilling. I also take 2-3 Duexis per day and that seems to help.

I feel stronger every day and my pain is really more achy that anything, at this point. Much like my OA used to be. I'm doing my PT 3x per day and actually enjoy it - cannot wait to be able to take a nice long walk (I'm up to about a third of a mile per day) and to get back to the gym. I try not to get frustrated about the lack of bend, but it's tough. I'm still not to the point where I am happy I had this done...hope to be there soon.

I will let you know if I am headed for MUA after my appointment on Thursday. Best wishes to all.

 

[DogLoverx3]

I'm sorry you're frustrated with your recovery. I know that feeling well. My ROM was VERY slow going and I was 'stuck' at 75 for almost 3 weeks. It came to me slowly (very slowly). I watched everyone around me in PT doing leaps and bounds better than I and it was hard not to get discouraged. I was on my walker longer than everyone else, limped longer than everyone else, had more swelling than everyone else, etc... and I wanted to just give up. I never had my ROM measured while on my stomach. I do find that my knee bends less when on my stomach than on my back, but I always sort of used the 'chair method' anyway. Could I bend it under the chair at all, etc.... Your extension is excellent for 6 weeks(ish). That was the hardest and most frustrating for me. Although I have several other issues going on with my knee at 13 months, my ROM is well over 145. I say this not to make you feel bad, but to show you that it can come in time. If everyone feels that an MUA would help you, however, then I will keep good thoughts for that as well. I do think 6 weeks is early for one (I know, easy for me to say), but will anxiously await an update regarding your appointment on Thursday. Hang in there and try to stay positive. I think you're doing great!

Oh, and as for working on your scar tissue around your incision, I found it more comfortable to do while in the shower, with warm water running over it and using a wash cloth.

 

[lunula]

Thanks, @DogLoverx3 !

Everyone who reads this, can you please tell me...what is your current flex, or what do you and your OS/PT aspire to?

I ask because I have this PT assistant who INSISTS that I shouldn't go past 120-125 because, "you need that stiffness in your knee to give you stability because you no longer have an ACL or PCL."

To me, this doesn't make any sense - especially after reading that DogLoverx3 is comfortably at 145! I have been reading a lot of posts about ROM and I see a lot of people regularly making it past 130. Today I corrected her and told at least wanted 130 and she was so upset with me and told me I would lose stability.

First off, how does one "stop" gaining flexion at a certain point? I read so many people here say they get more and more flexion months and years later, just due to everyday use.

I have never heard that stiffness gives me stability, or that I shouldn't shoot for more than 120-125. I am starting to doubt her abilities. [emoji20]

 

[treypops]

@lunula
That sounds like crazy talk to me. My latest rom measurement (this morning) was 128. We've not set any aspirations really, but my PT is happy with where I am and wants to continue seeing improvement.

Whew, my pain is out of this world today, though!

 

[DogLoverx3]

Hiya! Never heard of that before. My PT said the average ROM for TKR is 120 and that anything over that is a bonus. My flexion has something to do with the laxity in my knee (which I don't really know what laxity is attributed to but think it has to do with spacer size maybe). I do think, though, that although my ROM is 145+, that the amount of laxity in my knee may be contributing to some of my other challenges. I would say to strive for the best you can, no clue why you would want to just give up once you reach a certain number.

 

[Celle]

I have this PT assistant who INSISTS that I shouldn't go past 120-125 because, "you need that stiffness in your knee to give you stability because you no longer have an ACL or PCL."

If you have surgery that removes the ACL and PCL, the surgeon uses a special type of implant that compensates for them and stabilises your knee, so your PT's fears are groundless.
This is a rather long article that shows the different types of implant:
https://bonesmart.org/knee/types-of-total-knee-implants/

I'm sure I've seen a simpler explanation, but I can't find it right now. I'll keep looking!

 

[Celle]

This isn't the article I was looking for (I'm sure @Josephine has a simpler one), but it has some useful diagrams and information:
https://orthoinfo.aaos.org/topic.cfm?topic=a00221
If you look at the illustrations for the posterior stabilised designs, you will see how the special design compensates for the lost PCL and keeps your knee stable.

I have two knee replacements like that and I have never been told that there should be a limit to how far I bend my knees. I haven't had my ROM measured, but I estimate that it is between 125 and 130 on both knees. That's enough for me, as it enables me to do everything I want.

 

[MotownGirl66]

Thanks, all. I will call my OS tomorrow and ask about adding more Tylenol in. I know it is completely normal because I read it on so many other threads before surgery, but I am regretting my choice and getting really depressed. I felt so positive in the hospital while my Exparel was still in effect, but I am not seeing any progress at all. My pain is controlled only with ice on, knee elevated, on Oxy and resting. Going to the restroom causes an hour of misery.

I, of course, will be patient and practice the mantras. I jus can't see myself ever getting the right knee done!


Sent from my iPad using Tapatalk

Oh my goodness! I so much understand your feelings about getting knee #2 done....BUT, I am going tomorrow to schedule it.

 

[TexasTee]

Hi @lunula - sorry you're still struggling but sounds like things are heading in the right direction? Your PT sounds a bit off, just in my opinion, perhaps ask her to bring you the medical studies she is referring too? Opinions are everywhere - if I'm supposed to buy into yours, you best be willing to prove it! I'll look forward to what your OS says later this week.

 

[Josephine]

I ask because I have this PT assistant who INSISTS that I shouldn't go past 120-125 because, "you need that stiffness in your knee to give you stability because you no longer have an ACL or PCL."

Well, there's one PT who should be given a wide berth! I'm sure she means well but she really doesn't know what she's talking about! To the best of my knowledge, there is no restriction upon the amount of flexion one could or should obtain. Every knee is different and the outcomes attained are also vastly different. It matters not whether you have had cruciate sparing or sacrificing knees or any other type of replacement.

To be fair, it's quite possible she heard another, more experience PT or a surgeon give this advice to a patient for some specific reason and mistakenly assumed it applied across the board.

 

[lunula]

Thanks, all - I thought it didn't sound right! I see my OS tomorrow, so I will ask for clarification. I swear, I have heard so many completely opposite recommendations through all of this that it makes my head spin! One PT tells me I am not working hard enough, the next one tells me I am doing too much. Then I am told work on bend, bend, bend and then a PT freaks out because I am not at zero extension. My OS tells me to concern myself more with ROM than with getting out and walking distances, yet another PT tells me I "must" walk at least a mile per day.

No wonder patients are so confused! Good to have a support group like BoneSmart!

 

[Wrangler]

Hi @lunula - I am 9 weeks out and still have around 60-70 degrees of ROM. I had an MUA 2 weeks ago - I was in the OR for the manipulation then spent the next 72 hours on a CPM machine 0-120 with an epidural. I had great ROM for 2 days after I got out - then the pain and stiffness came back. I am just starting to feel better and my home PT sessions are more comfortable and the bend is easier. I am still on crutches as it's the only way I can walk without looking like the bride of Frankenstein. I am confident that more ROM will come as the weeks pass.
I do get frustrated and a bit blue sometimes. I try to keep my chin up and only compare myself with others that have had complicated recoveries. There are some amazing threads out there. I hope you have a good conversation with your OS and get un-confused. I wish you all the best in your recovery!