TKR Almost 5 weeks out TKR

JJT

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I'm a bit concerned and have been "yelled" at by PT. I am at a tough 86 degrees flexion with 15 degrees short on straightening. PT wants to talk to doc about MUA. I said I would not agree and PT went south after that.

For a bit of history, I was in a car accident 40 years ago and my patella was broken in three places and had to be wired together. Three months in full leg cast and then PT. When they couldn't get the bend, they did a MUA. I finally left the hospital at 90 degrees six months later. I had other broken bones and injuries and that's why the long hospital stay. I believe I may have gotten to 115 or 120 degrees over time with normal activity. My knee has always been painful. Over the last year, my ROM worsened in both directions and 10/4 I went into surgery.

The nerve block didn't work and the pain medication wasn't strong enough for a week afterwards so I lost PT time there. I am scared. PT has pushed and pulled on my knee. They've forced me to sit in a chair with my foot on a riser and push myself forcefully forward to try to bend the knee. It's extremely painful. They said my muscles are guarding and if I don't get them to stop doing that, I won't gain anything back. Working at home, I push to the point of being uncomfortable but I simply can't push myself to pain and I back off. I'm told that is wrong. My mantra should be "It hurts but it won't hurt me".

Am I the only one who has gotten stuck with such limited bend this far in? I'm afraid of another MUA. It didn't work the first time, what's to say it would this time either and I do not want to go back to square one. Swelling is okay, stiffness is awful the day after PT but loosens up the day after that and then I can work out at home again. I'm still using a cane but can walk for short periods without it.
 
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Pumpkin

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@JJT
Welcome to BoneSmart, glad you joined us!! :welome:
I'm still using a cane but can walk for short periods without it.
Sounds like you are doing great at one month out from your TKR.

PT has pushed and pulled on my knee.
No wonder you have awful stiffness the day after PT. It also sounds like your PT is out of date with TKR recovery. Ask for a different PT or go to another clinic.

Working at home, I push to the point of being uncomfortable
Perfect, this is what we recommend for ROM at home.

They said my muscles are guarding and if I don't get them to stop doing that, I won't gain anything back.
Your ROM of 86 degrees is fine for one month out. You have plenty of time to gain ROM, it takes time and patience in this year long+ recovery. Time for your knee to heal, time for swelling and stiffness to go down, allowing your ROM to reveal itself.

My mantra should be "It hurts but it won't hurt me".
A better Mantra would be Pain, No Gain. You are in recovery not rehabilitation.

We recommend these two gentle activities for ROM.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

In the next post I will leave you our recovery guidelines.
 

Pumpkin

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Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

Knee Recovery: The Guidelines
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
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

5. At week 4 and after you should follow this

6. Access these pages on the website


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?

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

OneStep information
 
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Pumpkin

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A few of our members who were slow to gain ROM shared their progress with us, here they are.

Campervan’s ROM history
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months and still this now at 1yr 10 months

Bertschb’s ROM history
1 month
- 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees



TortiTabby's ROM
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
It has now been 26 weeks and all I do is ADL.
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better.
 

sistersinhim

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I'm one of those who never took formal PT. I've had 12 knee surgeries, 2 of them kneecap removals, and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around and do nothing, I used my knee as it was intended to be used by walking around to take care of my daily needs along with the necessary house and yard work. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happened to me, I found that resting, icing, and elevating helped. Your knee knows how to rehab itself without being told what to do.
 

JusticeRider

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Yep, @JJT, I am navigating a similar situation to yours. I too have a long history of a painful knee (though not as traumatic as yours!). My ROM had gotten terrible before this surgery as a result of severe pain on bending. Since the surgery, my ROM has been very slow coming back. Like 2 degrees a week slow. They also threatened me with a MUA and though my PT has been relatively understanding, my surgeon hasn’t contacted me or answered my message since I refused it. I had to completely let go of measuring or worrying about my bend. I refuse to let anyone hurt me or to hurt myself. Reading many, many other’s accounts on BoneSmart has shown me that it can take time, but it will come back with gentle care and daily activities. There is not a time limit or deadline for getting it back. My neighbor just told me last week that it took her two years, but she gained her full ROM without pain. I’d like to get it sooner, but if that’s what my own knee needs, I can be patient.
 
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JJT

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Thank you so much for the kind responses and encouragement. I worked too hard before I posted yesterday and paid for it all day and last night. I won't do that again. I will let my body heal.

I see the doctor on the 18th and I will be in command of my recovery.
 

Layla

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I'm a bit concerned and have been "yelled" at by PT.
Please don't allow anyone to disrespect you in this way. If this occurs again, I suggest you find an alternate therapist.

It's good to read that you've decided to be the judge of how you recover. I am sorry you're hurting today, I hope the discomfort eases soon and I wish you all the best with your appointment on November 18th.
Happy Sunday!
 

Layla

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Hello and a Happy Two Month Anniversary to you!
I am wondering how your appointment went on the 18th?
Hopefully it was good and left a smile on your face with reassurance from your surgeon that all is well.
Have a wonderful holiday season!
@JJT
 
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JJT

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I need advice. I agreed to the MUA. The surgeon said he easily got me to 115. He did not press further. I came out and immediately went to PT the next day. I was at 93. Everyday for two weeks, PT where I slid back to 86 and very slowly went to 95 max and 9 extension over the next several weeks. From about 86 to 95 still takes me a bit of warming up and pushing.

I'm down to PT once a week and doing it on my own 1 to 2 times a day. At PT, I've insisted no pushing at all to painful bending. I had dry needling on the front of my knee which completely resolved my pain in the front. I now only get banded feeling which doesn't bother me. I had dry needling to the back of my knee which removed quite a bit of pain to a certain bend level. I had another one today because the pain returned 4 days after the 1st one. It is terrible pain in the bend, just above the bend and into my calf.

The surgeon has no clue what's wrong and neither does PT. I keep hearing I'm unconsciously guarding and that's why I can't get to 115. My PT says my muscles in the back of my leg are extremely tight. The surgeon put me on Gabepatin (sp) and I did not tolerate that well at all. I have trouble walking anyway and this caused me to have a very difficult time walking in a straight line even though I wasn't feeling dizzy. I quit taking it.

PT said today I needed to look at alternate therapies because they don't know what else to do. I was told to call a chiropractor and a massage therapist. I was also told to take a week off and do no PT at all which scares me because if I lost what I have, I'm afraid I won't get it back.

Does anyone know what the pain in the back of the knee could be and how to resolve this? The front feels like if I didn't have pain in the back I could bend it.

For a bit of history on this "so totally over it" leg of mine, I was in a car accident about 40 years ago. The dashboard went through my knee breaking the knee cap in 3 places which was then wired together. I was then put into a cast from hip to ankle. When the cast came off, PT started and they pushed the bend until I was screaming. After several PT sessions, they did an MUA. Even after that, I only ever reached 90 degrees. Once I left the hospital (I had several other broken bones so was in the hospital for a few months) I gained some additional bend at probably 110. I've lived my life. Over the past two years, the pain increased to the point that I lost flexion and quite a bit of extension. My quality of life changed so I made the choice for the TKR. Since the dry needling in the front of my knee, I am now not as sorry I had this done. It's the first time since I had the car accident I've been out of pain in that area.

I just feel like, I don't know what to do anymore and have lost all of my steam and that is so not like me. Deep breath, tomorrow will be better.
 

sistersinhim

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I think you should stop all exercises and let your knee settle down. It is obviously quite inflamed and swollen. You can not bend a swollen knee very well. Doing all those exercises is not working and keeps it swollen. That's why the bend isn't better. Can you easily bend and water hose that is full of water with the nozzle closed? Nope. Your knee is the same way. You have been working it so hard for so long that it hasn't had a chance to heal and the inflammation to leave it allowing the swelling to decrease.

Stopping all exercises won't cause you to lose ROM. In a few weeks when that knee becomes less inflamed and swollen, then the ROM will naturally improve. As for the back of the knee, are you icing it, too? You will find that to be a big help. It's also possible you might have a Baker's cyst that flares up. They aren't that unusual. I've had one for years and when I do too much it swells and gets quite painful. I ice it and do nothing but my daily activities for 3 or 4 days and it goes right back down taking the pain with it!
 

Jockette

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I'm down to PT once a week and doing it on my own 1 to 2 times a day.

The surgeon has no clue what's wrong and neither does PT. I keep hearing I'm unconsciously guarding and that's why I can't get to 115.

My PT says my muscles in the back of my leg are extremely tight.

PT said today I needed to look at alternate therapies because they don't know what else to do.



I think you should stop all exercises and let your knee settle down.
Since your medical team doesn’t know what to advise you, and what you’re currently doing is not helping, try what sistersinhim suggested, stopping
all the formal exercises and let the movements you get during your day be your natural exercise. Sometimes we just have to let our healing knee just “be” so it can relax and heal.
 

JusticeRider

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I keep hearing I'm unconsciously guarding and that's why I can't get to 115
Ooh this just makes me so mad. Of course you’re subconsciously guarding! Because your body knows it’s swollen and it hurts! It’s protecting itself, as it should. These docs need to give our bodies a little more credit. Your poor knee has been through so much. It’s been cut up and manhandled and overworked. It hasn’t even been given a chance to heal.
I was told to call a chiropractor and a massage therapist
I personally have found massage therapy to be a game changer and a huge blessing. There are therapists who specifically do medical massage and post surgical massage and lymphatic drainage (for swelling). The first time I went and someone touched my knee in a way that was gentle and nonjudgmental and healing, I almost cried.
I just feel like, I don't know what to do anymore and have lost all of my steam and that is so not like me
I’m so sorry for everything you’ve been through. You must be exhausted and discouraged. Give yourself (and your healing knee) permission to rest. Listen to these wise ladies on here and trust your body. The bend will improve as your swelling goes down. But in order for that to happen, your knee needs a break.
Sending you good vibes, JJT
 

EalingGran

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It's also possible you might have a Baker's cyst that flares up. They aren't that unusual. I've had one for years
Agree with @sistersinhim I had a 45mm diameter Baker's cyst pre surgery and that definitely caused pain at the back of my knee. It has reduced a lot now and the pain at the back has pretty much gone- although it can swell and tighten slightly if I do too much.
So sorry to hear of your troubles. There is lots of good advice here. Just take it easy and don't be discouraged.
 
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JJT

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Thank you for all of the replies. I am going to stop the PT and rest my leg. I do think that I'm very much over doing it and when that's not working, I have no choice but to do the opposite. I've wanted to just live life for awhile now because the stress is getting to be too much but the fear of losing ROM has been too strong.

I do wonder about the Baker's Cyst and while there isn't a physical appearance of one, there very well could be. I am going back to icing the back of my knee, something PT said to stop doing over a month ago for my entire knee. I'm also going to find someone for massage and see where that gets me.

This site is fantastic. The support helps so much and my knee thanks you.
 

Jaycey

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going back to icing the back of my knee, something PT said to stop doing over a month ago for my entire knee.
Why? I can't understand this. Icing helps reduce inflammation. Inflammation is what is limiting your ROM. Rest, ice and elevate whenever you can.
 
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JJT

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going back to icing the back of my knee, something PT said to stop doing over a month ago for my entire knee.
Why? I can't understand this. Icing helps reduce inflammation. Inflammation is what is limiting your ROM. Rest, ice and elevate whenever you can.
PT said it was causing fluid to rush to the area causing further stiffness.
 

benne68

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PT said it was causing fluid to rush to the area causing further stiffness.
Your PT is confusing the use of ice after injury with the use of ice after surgery. There's a big difference.

I'm glad you are ignoring that advice and icing again. Hope things improve soon!
 

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