TKR An Outdoor Lover's Recovery

[Jockette]

Maybe most patients do fine either way, but they're just trying to prevent less common, but potentially serious issues like adhesions?

Aggressive exercises do not prevent adhesions. If anything, aggressive exercises can contribute to getting adhesions. Here is an article from the Bonesmart library:

MUA (Manipulation under Anaesthetic) and adhesions

First let me first put your mind at rest - this is quite probably nothing to do with not having done enough PT or been 'good enough' in following orders. Here is my standard mini-lecture on the subject so read and absorb ... All the structures in the body, muscles, tendons, ligaments, even gut...

bonesmart.org

I, also, wonder why so many promote the more aggressive rehab, but I know it didn’t work for me, and I will never attempt it again. It caused me great pain, increased swelling, which literally took days to recover from. Even before I found Bonesmart I was telling my husband that it was counterproductive.

I no longer worry about that question, as in the 4 years that I have been a part of Bonesmart, I’ve seen many conflicting opinions about this recovery, and I’ve learned there is no one way to recover/rehab, as each of us is different. What works for one of us, may not work for someone else, and that’s ok. Our choice of rehab is indeed our choice. First of all we have to listen to our body, and how it responds to the rehab we choose. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are here to help, but you are the final judge as to the recovery approach you choose.

I see a big downside to being told it is essential not to miss the window-of-opportunity to regain ROM -- recovery is stress enough without trying to second-guess the advice we're receiving from our medical team.

I agree. Because my PTs and surgeons were fans of pushing my bend to a very painful level (before I’d had enough and refused to let them do it) the numbers they recorded look great on my record. But because I hadn’t healed enough to get that number on my own, I didn’t have the function that the number implied, so what good is that number on my record?

I also had 2 major setbacks, one at 4 months and one at 5 months, which resulted in a rather poor ROM. I don't know what the number was, as I wasn’t being measured at that time, but my function was very poor. As I gradually healed, I found that my ROM continued to increase not only in my second year, but also my third. It made me made angry to think of all the pressure early on to regain a certain ROM number and how worried my medical team made me. I won’t be making that mistake again, as I’ve gotten to the end and seen the proof of recovery, with a ROM thats fine.

 

[sistersinhim]

My OS and many others don't believe in that 'window of opportunity' or aggressive PT. I've had 12 knee surgeries with 6 different surgeons and neither one of them wanted me to have a certain number by a certain time, nor prescribed aggressive PT. None of them asked me anything about the PT that I was not going to. What was important to them was what my knees would do. I believe the majority of the OSs this day in time are not concerned about that 'window' or buy into the aggressive PT recovery after a joint replacement.

 

[Kneeophyte]

I'm approaching the three-month mark. I notice the knee & ankle of my TKR leg are visibly swollen at the end of the day. That happens whether I've done very little all day or whether I've included a non-level walk of a mile+ in our activities. (We're on a visit to Joshua Tree Nat'l Park; it was supposed to happen in Jan. before my surgery, but it had to be postponed due to a COVID19 surge).

Kind of typical to have swelling like that, unaffected by activity level?

 

[Jaycey]

Swelling is totally normal at this stage and it may continue for some time. Just keep icing and elevating when you can. Remember, full recovery from TKR can take one year or longer.

 

[FCBayern]

I still had some swelling by the end of the day at 3 months too @Kneeophyte. All I had to do was be vertical. Ice and elevation when you can, that and time are the only cure, but it does get better. All part of the ride.

 

[Kneeophyte]

Thanks @Jaycey & @FCBayern. Despite being in the desert, evenings were chilly. Socks that made it into the suitcase turned out to be awfully tight on that puffy ankle...

 

[Kneeophyte]

I think it will still be awhile before I can return to hikes of more than a few miles & that involve a lot of elevation changes. But while we were in Joshua Tree National Park last week, I was encouraged that it was possible to manage a couple miles on trails that were mostly, but not totally, level. It was time for the new knee to realize that there is more to walking than our suburban neighborhood sidewalks.

 

[Jockette]

I was encouraged that it was possible to manage a couple miles

I am amazed that you were able to walk a couple of miles so early in recovery! You’re doing great!

 

[newlybionic]

I’m two weeks before your TKR and I still get swelling from my knee down through my ankle. I have to ice and elevate everyday after work. I’m on my feet a lot. On days off I can still swell if I don’t elevate my knee and leg. It’s still quite normal to have swelling at this point. All we can do is ice and elevate!

 

[AussieRodney]

Holy moly, that is fantastic!

I'm one week behind you and I still can't walk without my frame for more than about 40 yards.

 

[Kneeophyte]

I have some older extreme-sports friends (a couple) who had three TKRs between them in 2020 & 2021 & with same surgeon as mine. They are shocked & find it hard to believe when I tell them I'm at three months post-surgery & that I'm not yet at the point of finding my knee "better" (less stiff, less achy, more functional) than pre-surgery.

But as this forum consistently stresses (regardless of my extreme-sports buddies), we obviously all heal at our own rate. @AussieRodney, I haven't forgotten that shocking photo showing your early-on exceptional flexion, totally beyond imagining for me at that time...actually now too. And @newlybionic, by evening I too have knee-to-ankle swelling, regardless of what I've done (sorry, think I'm repeating an earlier comment).

@Jockette, @newlybionic, & @AussieRodney: Thanks for the positive comments.

 

[Kneeophyte]

Back in March I wrote:

My PCP recommended avoiding antibiotics before dental visits, including this statement in her response to me:
"In view of these observations, the American Academy of Oral Medicine [broken link removed: https://myhealthonline.sutterhealth.org/contents/prevention-of-prosthetic-joint-and-other-types-of-orthopedic-hardware-infection/abstract/42], the American Dental Association (ADA) in conjunction with the American Academy of Orthopedic Surgeons (AAOS) [broken link removed: https://myhealthonline.sutterhealth.org/contents/prevention-of-prosthetic-joint-and-other-types-of-orthopedic-hardware-infection/abstract/37,43], and the British Society for Antimicrobial Chemotherapy [broken link removed: https://myhealthonline.sutterhealth.org/contents/prevention-of-prosthetic-joint-and-other-types-of-orthopedic-hardware-infection/abstract/44] all advise against universal use of antimicrobial prophylaxis prior to dental procedures for prevention of PJI."
I see 'PJI' stands for periprosthetic joint infection associated with knee & hip replacements.

Yesterday was my first post-TKR visit to my dentist. I'd kind of forgotten that some dentists still expect patients who've had joint replacements to use antibiotics in advance of dental visits. Turned out my long-term dentist DID expect that, so we had quite a discussion. In the end he agreed to proceed, but asked me to bring an MD-signed statement saying no antibiotics would be needed before future dental visits.

I'm glad he was that flexible. He's a fine dentist & very nice person & I would have been sorry to have to find someone else. Interestingly, before I left the office, he told me he'd had a knee replacement himself...... I guess unless you experienced C. diff as the result of antibiotics (or known someone who had it), concern over the use of a single, relatively small dose can be hard to understand.

 

[Jockette]

concern over the use of a single, relatively small dose can be hard to understand.

My personal opinion is that it’s not a small dose. I think it’s a rather big amount all at once.

I‘m glad your dentist respected your opinion.

 

[Kneeophyte]

@FCBayern & others who go scuba diving or serious snorkeling: is there any issue with using good-sized swim fins post-TKR? If you returned to using those, did you do anything special to prepare?

 

[FCBayern]

The first time I dove was only 4 months post TKR @Kneeophyte, and that trip I needed to use smaller fins to be comfortable, I also needed my BCD lifted into the boat before I could climb the ladder. Now I use a pretty large set of fins and comfortably climb the ladder with all my gear on. I would probably wait a year before using big fins, and just use something smaller if you want to go sooner. Aggravating a knee is no way to enjoy a trip.

 

[Bikeknit]

such a puzzling divide between what surgeons (at least apparently many in the US) say about PT & the "window of opportunity" in contrast to the experiences reported here/the BoneSmart recommendations!

Are there studies that some surgeons accept and others reject?

I know you wrote this awhile back but it is something that troubles me as well. I was once a medical librarian so I did some fairly extensive searching for studies related to how much and what kind of physical therapy is best after knee replacement and what I found was pretty sparse. I found a couple of mega studies that ended up saying essentially there isn't much data and what studies have been done weren't very rigorous.

I personally think that doctors give out the advice they were taught for years and they find it difficult to adjust that mindset even given new evidence. Medical knowledge evolves and new information is adopted in different places at different rates. Read "Destiny of the Republic: a tale of madness, medicine, and the murder of a president" for an interesting perspective on the slowness of medical practice catching up with new knowledge.

I finally decided that my OS is a skilled surgeon with a blind spot related to this issue. I took a middle ground on the pt issue.

 

[Kneeophyte]

@Bikeknit - Thanks for sharing your findings & thoughts on this topic. Much of my career has involved medical device manufacturers & clinical studies are extremely important in that world. But of course for the question of a limited "window of opportunity" for ROM recovery after a TKR & on question of the value of early & rigorous PT, there isn't such an obvious way for anyone to profit......

"Destiny of the Republic: a tale of madness, medicine, and the murder of a president" sounds like a must-read!

 

[VolFan0927]

@Kneeophyte - How is your recovery coming along? My wifes ROM is slowly improving, albeit a traumatic break 4 mo ago with surgery. She is having trouble adding ROM, but has alot of swelling and hamstring tightness.

 

[Kneeophyte]

@VolFan0927 & other friends: Somehow over a month has gone by since I last posted, I'm not sure how that happened, but it is probably a good sign.....

In mid-May on a local get-away & about 3.5 months post-TKR, I did a 6+ mile hike on a very easy (smooth & level) trail. A day or two earlier, I'd hiked 4+ miles on an easy, but less totally flat & smooth trail. A bit to my surprise (& definite pleasure), I didn't really have bad after-effects from either of those hikes.

Otherwise since my late Jan 2021 TRK, I've mostly just been doing my best to return to my regular pre-surgery activities, lap swimming 2-3x per week, taking a weekly 2-3 mile neighborhood walk with a friend, plus doing some no-resistance & very brief stationary biking most days. I'm also in the OneStep online PT program & go through most of their recommended exercises a few time per week (not quite as frequently as recommended, but oh well!).

Though I was told by several medical experts that my pre-TKR knee was in bad shape (bone-on-bone & very much bowed inward), before surgery, I mostly only noticed knee limits & pain when hiking or XC skiing on non-level trails (or in the days right after those activities).

At this point (now about 4.5 months post TKR) I still have more day-by-day achiness & less range of motion (ROM) from that knee than I had pre-TKR. But my leg is now straight & both the ROM & achiness are gradually, steadily improving. So I do expect to reach the point where it all feels & functions better than it did pre-TKR.

 

[Jockette]

That’s a great update, you’re doing very well!