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TKR Four Months Post TKR

Roux

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I am entering my 12 th post op week From left tkr. Surgery date nov 5 2019. I am having difficulty with flexion and extension. With any exercise I develop swelling and stiffness which impairs my rom. Is this normal? I am so frustrated with my progress. I have 105 degrees of flex ion and -5 to -7 extension. Extension improves with stretching. My ortho,says it just takes time. I have recumbent bike which I use twice a day . I am able to go up and down the stairs which I could not do before surgery. And no longer have the pain I had before surgery. Just this constant post op sensation of swelling which restricts my movement. I ice and elevate frequently. Am unable to take nsaids due to anaphylaxis. I have been doing everything I am supposed to and then some. Any suggestions.There are so many different schools of thought. My pt says no pain no gain. Same as my ortho. It’s hard to know what is the right way to go
 
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Jaycey

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@Roux Welcome to BoneSmart! Which knee had the surgery? We will make a signature for you.

Excessive exercise leads to exactly what you are feeling. Swelling prevents ROM. Sounds like you are over working that knee. I would cut back on all that exercise and let that knee settle. Over time you will continue to build ROM.

Here are some guidelines for you:
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 Activity progression for TKRs

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 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.
 

Teeboxx

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I feel your pain! I had RTKR on 9/12. It’s going to take some time! Some people recover faster than others but go at your own pace. Ice is going to be your best friend! It’s the best pain reliever and will reduce the swelling. I was a total wreck about progress until this message board eased my mind. Good luck!
 

Seatides

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Hi @Roux! I had my left TKR on November 13, so we're at about the same stage in our recoveries. What you're describing sounds exactly like how I feel lately. First, though, I agree with @Jaycey (based on my own experience) that the "no pain, no gain" is wrong when it comes to TKR recovery; overdoing the PT only interferes with your progress by increasing your swelling and stiffness.

This stage of the recovery process, I'm finding, can be very frustrating because we feel "better," but then when we try to do something we think we should be able to do by now, we get all stiff and swollen again. I like this paragraph from the "Activity Progression for TKRs" post that Jaycey included in her post to you (which applies to both you and me at this 10-11 week stage):

"Week 10 add to all the previous
Bed making and changing sheets, cleaning bedrooms etc., can wait now by which time, all things being well, you should pretty much start getting back to normal but don't rush it. If you start getting pain and stiffness in your knee, that's a sign your knee doesn't like what you're doing, that you're rushing ahead too fast. Slow down, right down, and start again. This stage might last until week 14 or even 16 but if it takes a even longer, don't worry about it."

So this tells me that what we're experiencing is normal at this stage. It's troubling at times because I tend to blame myself if something isn't working out the way I think it should; it must be my fault that my knee continues to be stiff and swollen when I'm more active than I think I should be able to be. I must be doing something wrong.

Then I start worrying about what other people may think (which is stupid, I know!): it's been 2-plus months, don't be a baby, don't be lazy, so what if you're tired, get moving, so-and-so was back at work and doing fine after 4 weeks! (People tell you stories.) It's all I can do to ignore this negative self-talk and thinking and stop comparing myself and what I'm feeling to anyone else. I think we have to have faith that we will get there by respecting our own individual bodies and recoveries! (I'm saying this for myself too.) It's so difficult to be patient about this, but I don't think we have a choice.
 

Celle

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Hello @Roux - and :welome:

This is a year-long recovery and there's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

As others advise, ease off the exercises and let your knee heal at its own pace.
It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. Give it the time it needs and it will get there.
 
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I concur. I've been resistant to ice as I never swelled much after the first week. But now I am seeing that with increased activity I need to ramp up the ice to reduce pain as it comes and redness. Brrrr.... so cold... :doh:. But icing really helps!
Ice is going to be your best friend! It’s the best pain reliever and will reduce the swelling. I was a total wreck about progress until this message board eased my mind. Good luck!
 
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Roux

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Thank you so much. This makes me feel much better. It’s reassuring that I am not the only one feeling like this . I keep comparing myself to others, and feel like I am doing something wrong. And being patient is really not in my dna. But I will keep plugging along and hope things improve. My physical therapist is so focused on me obtaining good,flexion and I get that but when I really push the exercise I pay for it later
 

Starsfan22

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I'm 6 mo. out and yesterday I did extra PT exercises and boy did I pay for it I do recover faster than before though. This for me is a long haul. I don't know anyone who has patience with recovery. In my case the nurse at the OS ofc. told me I would be so happy by 3 mo. that I had the surgery. I'm still not happy, but getting better, just slowly.
 

caredFL

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I am right there with you as I had my surgery 10/28 and if I push my flex I can get 112 but really it's about 108. I do have good extension but it gets frustrating for sure with the flex. My PT is good about it and doesn't push. I think this will be my last week of formal PT. My OS likes the pool so I will just plug along and do some pool therapy and see if it helps but I'm not going to push it as I truly believe in the end we get what we get.
 

Celle

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My physical therapist is so focused on me obtaining good,flexion and I get that but when I really push the exercise I pay for it later
Well of course she/he is. It makes her/him look good and fits in with the myth about the "window of opportunity", which should have died long ago..

But isn't the object of PT to help you and your knee, not to make your PT look good?

PT that hurts at the time, or later, is bad PT. It's counter-productive because it increases inflammation in your soft tissues, which can also increase swelling - and swelling can slow down ROM development.

Knee recovery - Lose the Work Ethic!!
TKR: work “smarter” and not “harder”
 
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Roux

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Can you please tell me signs of arthrofibrosis. I am so afraid of developing this that i am becoming depressed due to lack of progress. When I wake up in the morning may flexion is probably at 90. And I need to stretch a lot or my extension is also very poor. With activity it increases gradually during the day. I do light exercise Bike stretching and flexion. But I am also having trouble with my hip and it band Also. But I walked around on a bad knee for many years and my gait was altered Prior to having surgery. Any suggestions on exercises or anything else I can do. I am so scared my ortho will tell me I need an Mua. Not something I want at all
 
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Roux

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So I have backed off the exercise as suggested. I do stretching several times a day, short spurts of the recumbent bike, walking and regular activity of daily living. My knee itself feels better.. not so much pain or swelling. But having issues with my it band and my quadriceps muscle is very stiff .. I feel like I may be losing range of motion in flexion. Is that normal. I am so afraid of losing range of motion. I am in healthcare and everything you have said makes medical sense to me. But since surgery they have pushed numbers and fear of adhesions. I am so scared of losing range of motion. Any suggestions
 

Tykey

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Yes, forget about numbers!
You seem convinced that adhesions are hiding in wait, only to jump out and concrete your knee together if you slack off at all.
You can either believe the advice you get on here, or not.
There are hundreds of recovery tales on here which say "take it easy" your knee will recover far easier and to the same extent as bullying it into submission.
 

Jockette

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Your ROM will vary, depending on a lot of things. It’s not a loss, it’s a fluctuation, a natural occurrence. Don’t worry.

This is a year long recovery, on average. I worried my whole first year that my ROM was not where it “should” be. My ROM continued to improve n my second year, and in my third year! Don’t be bullied by the now or never theory, it doesn’t exist. :console2:
 
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Roux

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Thank you to everyone for your input. I just need to stop worrying. As hard as that is to do. Can someone tell me at 12 weeks post op. What type of exercises you are doing. I know what my physical therapist has told me but would like your input as well. Thank you
 
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Jockette

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Can someone tell me at 12 weeks post op. What type of exercises you are doing.
Before we answer this, tell us what kind of activities you do in the course of a normal day/week.
 

Celle

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But since surgery they have pushed numbers and fear of adhesions. I am so scared of losing range of motion.
I have 105 degrees of flex ion and -5 to -7 extension. Extension improves with stretching. My ortho,says it just takes time
Your ortho is right. Stop worrying about those numbers and just let your knee continue to heal and improve. Remember that complete recovery takes a full year, so you're still only a quarter of the way there. You have plenty of time for improvement.

Here are a couple of examples from people whose ROM took a while to develop, but they got there in the end:

First, from Campervan. As you can see, her flexion continued to improve for a long time.

"I had a slow recovery. Here's my flex measurements at various points:
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
128 – 6 years "


Then, from bertschb:
I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
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

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.


Can someone tell me at 12 weeks post op. What type of exercises you are doing. I know what my physical therapist has told me but would like your input as well. Thank you
At 12 weeks, I wasn't doing any exercises - just living my life and getting my exercise through my normal activities of daily living. Walking was my best exercise.
 
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Roux

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I do yoga stretches in the morning. I ride the recumbent bike three times a day for 10 minutes. Do extension exercises 3 x a day. knee slides 2-3 x a day. Then normal activity. House cleaning cooking laundry Normal walking. Physical therapy once a week
 

Jockette

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I think you are overworking your knee. I was discharged from PT at 8 weeks. After that I just did my daily activities.
House cleaning cooking laundry Normal walking.
This is the best exercise for your knee because it involves normal movements.

If it was me I’d drop most of these exercises and ride the bike 10 minutes only once a day, if I had a bike, which I don’t, so it was not part of my rehab.

It is implied to us the more exercises we do, the better we will recover, and that’s not true. As Celle said, you are only 1/4 the way recovered. Where you are now is most definitely not where you will end up.

Cut back on most of those extra exercises and allow your knee the privilege of sorting itself out in the healing process. Your ROM is fine. Too many specific exercises will just keep it irritated which hinders ROM improvement.
Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
 

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