TKR Cyclist - Managing My Recovery

[trailspud]

12th day- ...knee still has swelling although I think it has decreased about an inch in the area just above the knee which was 17 1/2 inch and is now down to 16 1/2 inch. I dont know of any normal daily movements that will bring it to 130 plus area. So I will have to use special exercises on this area. Lowering the seat on my stationary might help with the flexion. I think I am at about 90 degrees without resistance or pain(not sure I can tell the difference) and with some discomfort it would probably go another 10 degrees. I worry about this area of recovery because on the whole it doesn't seemed to have improved much in therms of increasing my flexion...

You are still very early so don't worry about the flexion. You will get it back if you take it slow. Gradually...and I mean gradually...lowering the seat height, as well as modifying foot placement and angle, helped me with extension after both TKRs. Start where you can make a rotation w/o pushing and go slow and easy. After a few mts, or a little longer, you may be able to drop the seat a peg or pull your foot back an inch or so requiring a very slight increase in flexion. 1 degree a day improvement will get there in decent time. Go with what your knee tells you.

 

[referee54]

I guess in my case swelling is just one of those areas that will improve at its own pace.

Yep---do not try to control the outcome---you are on the knee's schedule now. Just do what you are supposed to--keep the knee happy, ice, elevate, and rest. The other stuff is up to the knee.

 

[patbike]

End of day 12. Today I do not have formal pt. I am using the time for 4 or five short walks about 3 to 6 min.
with rest and cpm and ice and elevation between as well as a few sets of four or five basic exercises all of which are only taken to the current range limit with no forcing. I am noticing however that after walking I feel some discomfort about half way down on the right side edge of my knee cap looking down with the pain seeming to be be just below the surface somewhere near the edge of the kneecap. There is no other real pain except this infact right now all other areas are painless. I will of course check it with my surgeon tomorrow. It is possible that this pain has been there all the time but I couldn't isolate it until the surrounding general discomfort had subsided. As I type the pain is waning which may be the ice kicking in, The pain is right now running from about 1 to 3 on a 0 to 10 scale. Also I am going to now research if I can start using heat yet interspersed with icing. I come off xarelto my blood thinner tomorrow.

 

[patbike]

looks like no heat until the swelling is gone. I will confirm later this AM when I visit my surgeon.

 

[patbike]

not much from the surgeon today, will return in about 4 weeks for a further check. As for today he said i could drive provided not using hydrocodine, can shower, swim in about 6 weeks, teeth cleaning by dentist in 6 to 8 weeks and to start outpatient therapy right away. he felt the progress was good and that flexion would require a reduction in swelling which will come with time and exercise.
also as I am walking I will no longer need the continuous motion machine.

 

[Josephine]

That all sounds very good, Pat. And I see your surgeon has some BoneSmart philosophies about him!

 

[patient 99]

Hi Patbike, being able to visit your surgeon on a regular basis must be so helpful. It doesn't work like that here in the UK. I saw my surgeon for an initial consultation pre op, again for 5 mins when he visited the ward after the op and a 3rd time after six weeks. At that stage he took ex-rays, checked my ROM, checked my leg for straightness and whether my TKR was fully load-bearing. He said everything was fine. That I didn't need any physio. Because he could see I was the worrying type he agreed to see me once more at the 16 wk stage - this is still to come.

You can see why Bonesmart is so valuable to me. But for Bonesmart I am on my own. Will continue to follow your progress with interest. Particularly with regard to your experiments with rest v exercise. Best wishes Pat99

 

[RICBAK1]

Thats normal for uk had my year check up and only saw orthonurse had x ray she said looks fine and to come back in 4 years unless any problems.

 

[Hopper]

Wow you can drive! Is that because surgery is on the left?
Are you walking with a cane?
I'm doing little walks and hoping it's ok.

 

[1ELISEA]

he said i could drive provided not using hydrocodine

Hi patbike
Been catching up on your great thread. Congrats on doing so well.
I had a right TKR and was driving around 3 weeks, but as your OS said, not while on drugs. I made my PT appts for first thing in the morning, took Tylenol, and waited until returning home before taking meds.

 

[patbike]

First day home from nursing facility. Probably walked a total half mile today including in town getting ice for the ice machine, meds and groceries. All felt well and no particular pain. After dinner I did some stretching and quad exercises and did feel some pain after but the ice is taking care of it as i write this note. Tomorrow I go to outpatient PT. I will drive myself. I was told I only need a cane if i am walking on significant inclines. I did try to see if I could turn the pedals on my stationary bike which I set up using my actual bike and a special mount. Mount can be bought for about $35 dollars on amazon. I could get on the bike but I could not quite do a full revolution when sitting on the seat. My seat is positioned on the high side in the same position I used to ride pre-operation. I'm hoping the additional flexion I need will come soon (reduction in swelling required per doctor)as I would like to use the bike with no resistance to help with recovery and fitness.

One other thing I felt a little nauseous today after I ate a snack around 4 pm but it subsided.


Will keep you posted.


Pat

 

[patbike]

Met with my new outpatient PT for the first time today. Spent most of the time evaluating me as to capabilities and pain levels primarily with respect to normal living skills. The questions are required by medicare. Medicare is not interested in making me a better cyclist. They are focused on daily living skills, my ability to take care of myself, drive and walk and to do minimize pain. OK well if I can do all that I will be able to cycle again as a by product of my medicare therapy. Pain is up and down but seldom intolerable and seems to be in a general decline. I will continue pain meds as long as there is any significant pain. Getting off pian pills is not my goal although they do come with disadvantages including for me, dry mouth, some nausea, minor dizziness and mild constipation.

My flexion per the therapist measurement hasn't changed much and is still in the low 90's. She is going to put me on an exercise bike next Tuesday and she says it is a good exercise even if I cant get the pedals all the way around. I have 5 exercises to do each day at home, twice a day for about 20 minutes or less each time. Doesn't seem like much but we are taking it easy and trying not to overdue it. I'm also walking around the house and I took the garbage cans up a fairly steep driveway tonight with no issue.

 

[Roy Gardiner]

I could get on the bike but I could not quite do a full revolution when sitting on the seat. My seat is positioned on the high side in the same position I used to ride pre-operation

Why not just raise the saddle as high as necessary?

 

[bikerchick1958]

It's been over 4 months since my surgery and I still can't do a full rotation on my bike. But not biking isn't an option for me. I found crank arm adjusters on the internet which make the rotation shorter. It isn't ideal, but I can still ride 50-60 miles at a time. Hills are more of a challenge, but can still be done. So don't worry too much - if you get these you will still be able to ride.

 

[patbike]

I am particularly glad to hear from you, thanks much and I do have questions.

Do you know what your flexion/bend is, mine is a little over 90 without much discomfort. Do the adjusters shorten one side or both sides of the pedals.
Do you feel like you are still improving and will eventually get enough range of motion that you can pedal without the adjusters? Can you tell if you lost much of your fitness while waiting to get back on the bike and if so is the fitness returning?

As you can see I am a little anxietal and starved for information related to biking. Any feed back appreciated and good luck with your recovery.

thanks
pb

 

[Hopper]

I'm listening with interest although I think I'm ages away from getting back on my bike.
I'm so looking forward to getting there.

 

[Roy Gardiner]

Riding a bike is easier for me now than before surgery. All aspects of cycling are limited by factors other than my knees. HTH

BTKR December 2011, back on the bike a few miles in Feb 2012, good miles in Mar, knees OK by May but fitness compromised a lot!

 

[Hopper]

That's good to hear.

 

[bikerchick1958]

Here's a link to the shorteners. They come as a pair.
https://www.upgradecycle.com/ride2-..._content=pla&gclid=CI-s-Zjqr7cCFelAMgodxDcAgQ

They aren't cheap, but they saved my spring. My social life revolves around biking and I feel cranky if I can't ride.

My comfortable ROM is about 95 degrees and has been since mid-Feb. It's a huge bother because I can't walk down stairs and it's tough walking over uneven ground. I thought biking would increase the ROM, but it hasn't. I'm having a MUA in June. From what I hear, MUAs done later on are much easier than earlier ones.

My legs weren't very strong when I started riding again in early April, but I think they have built back up. Not to where they were last summer, but good enough. I couldn't ride as much as I wanted to because we were getting tons and tons of rain and snow. Once the weather improved and I could ride regularly, strength came back quicker than I expected. At first my thigh would ache after about 30 miles, but now I can ride over 50 miles without trouble. I can finally keep up with my friends. Hills are still a challenge, but I think that's partly due to the fact that I can't clip in - I have the arch of my foot on the pedal instead of the ball of my foot. Shortly after I started riding, that tight band feeling in my knee went away, which was a huge bonus. I think riding has really helped my recovery.

I had to take it easy for about 10 weeks after the surgery because I would just get way too exhausted. I started riding again at about 12 weeks and was only able to ride 5 miles. But it felt fantastic!

What do you ride? I have a Trek 4.5 Domane. I just bought it last month as a sort of prize to myself for going through the TKR.

 

[patbike]

I have been riding mtn bikes on the road for 10 years about 20 miles 5-6 days a week. My current mtn bike is a Giant with 29 inch wheels. Last November I put on road tires and started riding with groups. There are many around here.
I was able to keep up on my 32 lb bike with no clips. Did a 60 miler a couple of weeks prior to tkr. I assume I will need a 110 - 120 degree ROM in order to use my current bike pedals but I'm not sure about that yet. In any case I'm around 90 plus.
As a reward i am looking at getting a new road bike. i am gonna look at the madone and domain 5.2 the orbea, specalized roubaix and cannondale synapse. However I want to wait til i can turn the pedals before I pick out the bike.
I have a older mtn bike set up on a stationary roller and I can't quite get the pedals around. Im staying off it for now but my PT says we will try the bike next week at PT

I thought the pedaling might help with ROM but based on what you say perhaps not. Im only 2 and 1/2 weeks so I dont know where I will end up ROM wise.

Jogging is out so there really is not an alternative for me to biking other than walking up hills but that can get boring.

I get a little jumpy when I cant bike.

I am gonna research MUA's