TKR Dr says trust the knee? How when it's unstable and gives out?

[mtnplayva]

Hello, I had a right total knee replacement on 2/7/22. This recovery is nothing like what I expected based on my many friends experience! My knee gives out multiple times every day when walking. It is really bad when walking up any type of slope. I saw the doctor last week and he said I just need to trust the knee. He sees nothing wrong structurally and wants me off of the walker. I've started using a cane or free walking between objects I can grab onto at home. I still use the walker when out of the house. It feels clunky and I feel movement in the joint when walking. I can feel the muscles moving around when I use them. I've been in PT since week 1. My range of motion is 0 - 110, although it feels like it's been tightening up recently and I can't bend it as well.

Has anyone else experienced this for this long? At 9 weeks I expected to be walking without anything and possibly be back to work. Now I feel like I will never walk normally again. I'm super depressed and my anxiety is sky high.

I've read so many articles and posts on this site but haven't found any that are similar this far into recovery. It seems to be something people experience early and then it goes away. Mine has been unstable and is still unstable. There's no rhyme or reason to when it gives out. Sometimes it's in the morning and sometimes it's in the evening but it happens multiple times every single day.

 

[Jaycey]

Welcome to BoneSmart!

At 9 weeks I expected to be walking without anything and possibly be back to work.

Well, your recovery is not going to be any other recovery. And 9 weeks is just the beginning in a process that can take one year or longer.

Your ROM sounds good to me. Please don't stress about this.

What does PT have you doing? I would focus on walking and getting most muscles to tighten up around the joint again. Let that knee get over all the trauma of surgery.

Here's a bit of reading for you:
Knee Recovery: The Guidelines
We are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart are here to help. But you have the final decision as to what approach you use.

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​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork​

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

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this Activity progression for TKRs

6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Closure​

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 a 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 history before providing advice.

 

[mtnplayva]

Thank you for the support. Your #1 Don’t worry is where I’m at right now. I don’t know how to trust this knee when it gives out so much. I’m doing a lot of strengthing exercises - leg raises, squats, step ups, calf raises and of course, heel slides. I know it’s getting stronger but it is giving out the same as it has for weeks. It’s frustrating and depressing.

 

[Jockette]

I’m doing a lot of strengthing exercises - leg raises, squats, step ups, calf raises and of course, heel slides. I know it’s getting stronger but it is giving out the same as it has for weeks.

The fact that your knee is giving out is telling you that your knee hasn’t yet healed enough to do this much strengthening. Take a break and let your knee rest and recover, then try again, gradually adding the exercises back.

Don‘t look at taking a break as doing nothing, look at it as giving your knee the best opportunity in which to heal.

 

[lovetocookandsew]

I had something similar happen to me at some point after one of my surgeries. My doctor told me it could be caused by my brain sensing the pain before my conscious self was aware of it, so it was reacting before I realized the pain. His explanation was much better than mine, as it was some time ago and I don't remember exactly how he explained it, but it turned out to be what was happening. I don't know if that's what you're experiencing or not, but, IMHO, it's something to think about.

You are doing a lot for 9 weeks out, which may be causing more pain, which may be causing that "giving out" feeling.

 

[patriciad]

I had an aggressive first PT appointment at 3 weeks out which gave me that giving out experience. My surgeon did an X ray that alleviated my fears re the prosthetic damage but did show tissue inflammation and something with the quad. It took 3 weeks of back to icing, resting and elevation with only the basic gentle exercises to heal. You mention that your joint seems stiffer. Swelling and inflammation cause stiffness - someone on here put it in a visual way in describing trying to bend a hose full of water - you can’t!
I’d miss PT and rest it completely for a week, no steps just heel slides, leg raises and short walks to see if it improves. Good luck.

 

[kneeper]

Good news that the doc says the structure is good.
I have to agree that easing off on the exercises may be just the thing you need even though it sounds opposite to what you would expect. I had the giving out for several weeks--just as you say, completely randomly-- but it gradually diminished as I naturally started walking more as I healed.

I have no proof of this, but based on my experiences wonder if the walking itself rather than "strengthening exercises" would help the muscles and so on adjust. It's ok to keep the cane for security for now.

 

[mtnplayva]

Thank you all - I spoke to the PT and he agreed that I am probably doing too much. It seems backwards to not do so much exercise when you need to strengthen muscles but I'm going to let my knee rest some and see if that helps.

 

[InkedMarie]

Sorry you learned the hard way about doing too much. It’s the over-did-it club. I’m a member as well. Rest, ice, elevate. I hope things get better.

Marie

 

[Jaycey]

It seems backwards to not do so much exercise when you need to strengthen muscles

Ah - but you do not need strengthening in these early days. Let that knee heal and there will be plenty of time for strength training. Slow and steady is the best approach.

 

[lovetocookandsew]

Think of it like a broken bone. You need to cast it for about 6 weeks, and let it rest and heal before removing the cast and starting to use and rehab it. When you have a TKR, they've done more than break a bone; they've sawed, cut, hammered, pounded, and so on, in your knee and surrounding area. Your knee needs time to recover before doing serious rehab. Walking, stretching gently and other similar activities in the early days and weeks, gives your knee time to recover from it's procedure. Even at two months out, your knee is still healing. You can do more today than you could day one, but you still need to listen to your knee.

If it breezes through an activity, with no pain or swelling, either right away or the following day, it's telling you that that was acceptable. But, if it loudly protests, swells, stiffens or hurts more than a mild ache, it isn't ready. Plus, sometimes it breezes through one day, but another day it complains, so listening to your knee is the best way to tell what it's ready for. If you do an exercise or activity, mild aches are okay, but actual pain is not a good idea. Swelling and extra stiffness are also forms of pain and need to be listened to. You'll have swelling with ADLs sometimes, such as walking too long at a time, or sitting for too long, so in these cases, backing off on the time or distance for a bit longer is a good idea.

 

[mtnplayva]

PT thinks it's a neuromuscular issue. I see the dr next week so I'll see what he thinks about that and what to do about it. Had a bad day on Saturday because it gave out about 20 times but it only gave out 1 time on Sunday so I was super happy then! This is such a long, long process. I'm at 10.5 weeks already and still suing a walker when out of the house and a cane when in the house.

 

[mtnplayva]

I'm finally seeing progress!! Had my first day of no giving out! Granted I didn't go anywhere that day but still did walking around the house and it felt stable. It's amazing that stopping some exercise helped! PT started doing cupping on my knee and leg so maybe that sped up the recovery too. I just bought a quad cane so hopefully I can start using it out of the house and finally ditch the walker. I sure did not plan on being on a walker 11 weeks into this process!! I'm supposed to go back to work in a week but I can't see that happening since my job is on my feet and very fast paced. Now if I can get two days in a row of no giving out....

 

[Susie-Q]

Yay! Glad you're seeing progress!

Slowing down and giving things time to heal really does make a difference.

 

[Jockette]

It's amazing that stopping some exercise helped!

It’s amazing, also, that more doctors and PTs don’t realize this! Movement is good, too much movement is not.

 

[patriciad]

Such good news. Hope it continues to improve.

 

[kneeper]

Great to hear you are seeing improvement!

 

[mtnplayva]

Well I am almost 17 weeks into this recovery and it is still buckling. I am walking around the house without the cane. Dr extended my leave but that expires next week and I don't feel that I've made much progress since I saw him last. I am very frustrated with how slow this has been! I'm afraid to go anywhere unless I have a motorized cart. I had to park kind of far away from my eye dr's office and had a hard time making it back to the car. People were asking me if I needed help! That is such a scary feeling - I know I took my pre-surgery mobility for granted! Has anyone heard of buckling happening this late in the recovery?

 

[DEL2022Jun-25]

Just wondering, what resources do you have in your area beyond PT? Does your medical center have a wellness side, that offers a Strength & Mobility class for you to enroll in? I would not enroll in a typical gym. No way. But these centers are usually for pre or post surgical or patients who have had a major medical event, and are done with PT, and now have to go into a longterm maintenance phase.

Prior to surgery, I did 3 months of a gentle Strength & Mobility class and 8 weeks Aqua Therapy to focus on core strength, gain, upper body, and leg strength and balance. We used free weights, weight machines, and balance exercises, all overseen by fitness instructors who really knew what they were doing (average person had a MA in Kinesiology). So I'm wondering if the added strengthening classes might help you gain the stability and endurance you need, all done in a safe setting. Let us know what you find, and best wishes!

 

[Claire56]

My Dr's PA recommended bike riding to tighten up the muscles around the knee. I didn't ask if she meant stationary or road bike but I doubt it matters. There have been many postings about how to get the bike set up if you aren't using a bike already.