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PKR Almost 3 week past PKR

You are correct, CATS. This is one thing that we stress here on BoneSmart - that no two recoveries are alike and one should not compare with others. As you say, there are many, many factors that go into what type of recovery one may have and it is impossible to predict how fast anyone will recover. We tell people to plan for what seems to be the "average" amount of time and activity required. Some will do better; others will be slower. Some are able to push a little harder with no swelling and pain as a result. Others not so. We are happy for those who have it a little easier. But we are also very watchful for those who are trying to push to quickly and are having unneeded pain and discomfort.
 
Being fit prior to surgery makes sense. I imagine if you are 50 pounds overweight, it would be a laborious recovery. Thanks for the links @IAPILOT

I was thinking of getting a rowing machine (yes, I know I won't be able to use it for weeks after surgery). I really liked running, but I'm a goody two shoes and will follow my OS recommendations of no more running. :(
 
Thank you, @IAPILOT but that's not my idea of pleasurable reading! Not that I need education from you but I have never said pre-op recovery wasn't to be done.

And what I KNOW about post-op recovery is written all over these forums. I don't say this lightly - I have see far too many people like the two patients in the 'seriously grave consequences' article. And my feelings about most exercises are detailed here BoneSmart philosophy for sensible post op therapy. In my professional and informed opinion, it can do far more harm than good. If you got away with it, that's fine and I'm pleased for you but that won't be the outcome for everybody.

https://orthoinfo.aaos.org/topic.cfm?topic=a00220
AAOS website - ergo doctor's opinions! Besides which, all I could see about pre-op PT was "ask you doctor"!

broken link removed: https://www.webmd.com/osteoarthritis/prepare-knee-replacement#1
Another doctor site andthe only comment I could find was this
"If possible, try to get in better shape before your surgery. If you're physically fit, you'll have a faster recovery time. Ask your doctor which exercises you should do before the operation."

ttps://www.ucdmc.ucdavis.edu/orthopaedics/pdfs/newknee_brochure.pdf
A handbook from a hospital. And again, very little comment about pre-op exercising. It just says "be fit as possible".
 
I'm guessing it varies. I just read a study dated March this year from the American Academy of Orthopaedic Surgeons:

In the study, "High-intensity versus Low-intensity Rehabilitation after Total Knee Arthroplasty: A Randomized Controlled Trial," researchers found that activating and exercising the quadriceps muscles as soon as possible after TKR may be the key to regaining optimal, post-surgical function in the knee and legs.

The quadriceps muscles in the front of the thigh are important for straightening and stabilizing the leg during movement. Most patients have difficulty fully activating i.e., contracting the quadriceps during the first month after surgery, which results in pronounced quadriceps weakness. Quadriceps activation may be improved through strengthening exercises or neuromuscular electrical stimulation, said senior author and orthopaedic surgeon Douglas Dennis, MD.

The study followed 162 patients at the University of Colorado who received a total knee replacement at Colorado Joint Replacement, the University of Colorado Hospital, or Panorama Orthopedics & Spine Center. Patients were divided into two groups for high and low-intensity therapy, with all patients receiving 25 physical therapy sessions over 12 weeks. Patients who activated more of their quadriceps or "quad" muscles earlier in their therapy showed better rehabilitation progress when it came to their abilities to climb stairs, a telltale sign of recovery after knee replacement.

"Quad activation is the biggest thing we have got to change to improve recovery and long-term function for knee replacement patients," said Dr. Dennis.

These findings may be especially important for patients under age 59--the fastest growing population undergoing knee replacement--who want to remain active after total knee replacement.

Naturally, no where in this study does it say push through excruciating pain. I think it's just common sense NOT to do that.
 
@IAPILOT Hi you sound as if you are progressing well. I have only my own opinion to go on and the advice of my surgeon, but I am with you that fitness prior to surgery is important and I feel was so for me. I had a PKR two years ago and it has been brilliant. I hope yours is as good when you are fully recovered.

Where I would differ from you is on the necessity for lots of formal exercise afterwards. You are still very early out from your surgery and why go through any pain at all if you don't have to? I had almost none in my own recovery and did some but not much exercise on them. It really wasn't necessary for me and I have a medical problem which meant getting off painkillers very early. At about 9 weeks I could walk up a very steep hill and down and I mean a couple of 100 feet up. Pleased with that I gradually increased walk and gentle gym work. At about 15 weeks, I could go back to walking 5 miles easily and doing my usual pre-surgery gym work. I see no virtue in exercising to the point of hurting when you are still healing.

I guess it's just a different way of taking on this challenge but for me less pain really meant more gain in ROM (+145) and progress.

Good luck with your recovery.
 
IAPILOT,

My experience has been similar. I was fit going into surgery and my PT and OS both commented that it has made a huge difference. I left the hospital with 120 degrees of flexion and -1.

Parts of recovery have been challenging-but I haven't doubted that my physical ability will return.
After all, I did the surgery so that I could do all of my 'stuff' without pain.


Laura
LTKR 21 November 2016
 
No doubt there are people who can recover quickly by torturing themselves. I'd rather have a steady, pain free improvement. It is a given that overdoing any exercise, even activities of daily living, can cause increased heat, swelling, pain, and loss of ROM. Everyone has to find their sweet spot in recovery, but most of us would be greatly set back by weight training (legs) and 5 mile walks.

I was fit before my surgery, having done gym workouts with weight training and aerobics for a few years before surgery. I am sure that was helpful toward my recovery. I am at a point where I am going to go back to the gym in a few days, but if there is any swelling or pain (either after or while doing it) I will stop and try again later.
 
There is no doubt that having muscles and tendons in good condition before surgery does make mobilization easier afterwards. I have had one knee replacement where I did not have this, due to decreasing mobility over a period of 9 years before surgery. For the other two knee replacements, my muscles and tendons were in good condition and I did find that moving around was easier.

However, no matter how fit you are before a knee replacement, it has no bearing on how fast the tissues wounded during surgery will heal. Whether you are a fit, healthy 40-year-old or a frail 80-year-old, the wounded tissues take the same amount of time to heal - a full year for complete internal healing. There is nothing you can do to speed that up.
 
Celle said:
T

However, no matter how fit you are before a knee replacement, it has no bearing on how fast the tissues wounded during surgery will heal. Whether you are a fit, healthy 40-year-old or a frail 80-year-old, the wounded tissues take the same amount of time to heal - a full year for complete internal healing. There is nothing you can do to speed that up.
Click to expand...
You took the words out of my mouth, Celle. I was totally out of shape by the time I had knee #1 due to pain and instability. My conditioning or lack thereof was noticeable in the recovery. I was able to exercise and do more until knee #2 hit the point of no return. I felt stronger as far as conditioning in recovery with knee #2 (and had a good leg to stand on :wink: ), but the knee itself made progress on about the same schedule over the first 12 weeks as knee #1.
 
:goodpost: No matter what we do before surgery our body is traumatized by the surgery and takes time to heal. The best pre-surgery I think anyone can do is upper body work. I sure wished I had more strength while using the hanging bars in the hospital and all through recovery.

My rehab PT told me there was no problem with my muscles, it was that my body needed reminded of how it was supposed to work.
 
@UACats70 .... if you would be so kind, please post a link to that study you quoted. If you check the forum rules, you'll see that we always will need the link to let the information remain in the public forum.
 
Thanks. That appears to be the article quoted.
 
IAPilot - did your doc say you could keep running? My Doc said not only no more running, but no more singles tennis, only doubles. Basically nothing that's high impact. Are you going to run anyway? There's a part of me that says keep running and worry about it later and part of me that knows I don't ever want to go through this surgery again.
 
Because my family has had knee problems and my younger sister is a runner she bought a zero gravity running machine. It was expensive, but she can feel a difference in her knees just trading off on road running and the zero gravity every few days. I believe TKRs can use a zero gravity machine.
 
@KellyBob - I have a friend of a friend who is an OS in Louisville. He told me that the only restrictions he gives his patients is no long distance run training (Marathons or half marathons). This is based on the assumption that a high level of consistent activity will keep the weight off. His example was that if you are overweight then you are doing a lot more damage to the knee joint day in and day out with just normal everyday activity than you would playing tennis, lifting heavy weights or running shorter distances at a healthy weight.

My OS is a little more conservative but basically said the same thing in that it's a trade off.......that I could do whatever I wanted but that it might speed up wear. Strictly from the perspective of limiting wear on your new knee the perfect world would be to maintain a healthy weight and limit high impact activity.

So, it's basically a trade off. If higher impact activity (outside of long distance running) keeps you at a healthy weight then your knee is better off (or at least no worse off) in the long run.
 
Kellybob,
My OS told me I could return to normal after the surgery. However when I say running It is not marathons.
I run while working football games, indoor football starts February and I won't be on the field until March.
Unless my OS or PT says I'm not ready, than I will work to become ready.

I know I will need to do my other leg next year and I would guess at some point in my distance future (hopefully)
I will need TKR.
 
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