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TKR Getting back to hiking and climbing.

@rustic yes the one at night is in fact a larger size so not as firm. it just helps against extra movement or twisting knee while sleeping. I remove bed getting up in morning. Any previous swelling from day before is gone an knee feels rested and easily flexible
 
This is my report for the 17th week. I’m just a couple days short of 4 months since surgery.

Outdoor conditions weren’t good for much fun around home this week. Not enough snow to ski or snowshoe. Lots of mud and puddles during the day, which freeze solid at night. Our cabin is surrounded by sheets of ice that we break up with pick axe, and/or spread bark chips on top of. I took a big fall on the icy front steps. Facing out, I landed on my butt, bruising only my ego. Whew.

Since conditions aren’t good for doing much outside, I’ve taken to doing exercise DVD’s in the mornings. Lots of stepping, side-stepping, and kicking. Some require light dumbbells. I went to the climbing gym three times in the last ten days and improved each time. I made it to the health club one day for a long workout: treadmill (two miles, on an incline), recumbent bike (ten minutes), and a bunch of stuff in the weight room (cable weights for back and upper body, quad extension machine, and calisthenics). On the weekend, when the sun finally came out, I braved the mud for a scramble up a steep hillside near home. That felt great.

I mostly kept my fitbit steps 5000 to 8000, but I went over 11,000 on the day that I used the treadmill, in addition to general chores, and a walking DVD earlier in the morning. That didn’t cause problems.

I iced twice this week, and used diclofenac cream a couple times. On the rare days when my knee skin is so sensitive that my pants bother me, I use lidocaine patches. I use some light compression bandages during the night, to reduce morning stiffness. Since my flex if fine, I’ve been working on my extension some lately. I made some progress, but I still can’t my leg totally straight.

To sum up, I’ve been having steady, incremental, progress with no significant setbacks. (knock on wood).
 
18 weeks down. Doing fine, but really getting antsy to start pushing farther out on harder hikes. I'm recovering more quickly from my present hikes (3 miles or less each). But, if I go farther, the delayed swelling affects what I can do the next day or two, and I don't want to deal with that.

The thing that helps me the most is climbing (indoor gym) twice a week. It pushes my flex limit some, and increases the range of motion which is actually useful (i.e. where I can actually exert some force). It gets my whole body tired in a good way, and is just plain fun. I get to spend two hours with my wife as well (rare these days, since I can't hike with her for the time being). Too bad more people can't make use of climbing as exercise. Sort of like skiing: if you were doing it before your surgery, you know how to make it safe. But learning climbing (or skiing) after TKR is probably risky.

I try to get in two hikes near home, and one treadmill session at a gym each week. The treadmills have full length mirrors in front of them, and I'm improving my gait, and increasing cadence. I do sideways and backwards drills first, then speed up to 3 mph, and add some incline.

I still go to PT once a week. I took a few weeks off during the Holidays, and realized how much PT had been helping, so I started back up. Last week was a typical session: I showed up "stiffer than average" (120 or less) due to a hike the previous evening, so we didn't bother measuring it formally. He did manual stretch/release on my hip flexors, and quads. Some of this is while laying on my back, leg hanging down off the edge of the table, so my psoas is really stretched. Then, he does my quads with a pulse type massager that is really strong. Since, my leg really seemed to be relaxing, we got out the protractor thingy and measured the flex at 133º (without help from him). Great improvement, and he never touched my knee! Then he did some massaging of the quad tendon spot, just above the kneecap. Loosened the other leg up some (it is real sore from taking "more than fair share"), and worked out kinks in my neck that I got from staring at my feet, and sleeping in a foreign bed for two months. We discussed one of my "strange pains" without conclusion, and he suggested adding more balance exercises to my home routine. I felt great when I left!

I'm sleeping well till 4 AM or so, but getting out of bed in the mornings is somewhat painful. Sort of a weird reminder. I wonder if that will go away eventually?

I recently upped my "work" on getting the leg to straighten more fully. That is a very different game than trying to flex more. Sharper pain. Less productive (lucky to gain a degree in a week). If I'm going to walk really fast again, I'd like that leg to go at least to 0º. My other leg hyperextends easily to -1, which is nice.
 
For many of us the extension takes longer to get to 0. I found the best way for me was to walk with really long strides, heal to toe gait. It takes a while, though. The tendons behind the knee are very large!
 
Hey TKR survivors,
Just finished my 19th week, and it was a good one.

1) A bit less pain each week during my main challenges (A hill climb/hike near my home, and indoor rock climbing twice a week).
2) Fewer icing sessions required (which is good because my cabin is sort of cold and I get chilled).
3) What I’ve been doing to get more extension has been working, and I’m down to a +1 now. I’m hoping to hit 0 in a week or two.
4) Climbing and descending stairs is getting better. I can go up two at a time on a good day. And, I can go up backwards, foot over foot, but I’m using the banister for that one.

I don’t want to make it sound like everything is perfect, so here are a few of my problem areas (I don't dwell on them much):
  1. My operated knee is somewhat painful in the mornings. Also, during the day, it hurts to stand up after sitting still for any length of time.
  2. I’ve been having colon problems ever since the surgery. Pain, and irregularity. Could be due to: lingering effect of the spinal, lingering effects of the pain drugs (but I’ve been off oxy for months now), lingering effect of the iron supplements that used for a few weeks not long ago, or something I haven’t thought of. Pretty clueless on this, actually.
  3. I had mild, stable, peripheral neuropathy for many (20) years before this surgery. The spinal anesthesia seems to have made it worse, and the effect seems at least semi-permanent. I’m getting lots of cramps in feet and toes as well as the more typical neuralgia’s. Both feet.
  4. I have a pretty bad “mystery pain.” Assume I’m sitting, with knees at 90 degrees (tibia is vertical). I lift my toes/forefoot, keeping the heel down as a pivot point. Then rotate my foot inwards and outwards. My tibia rotates with the foot, while my femur remains still. This is painful deep inside. It relates to why I can’t yet cross my legs ankle over knee. And it relates to the pain I get exiting a vehicle on the driver side. It also hurts during certain types of rock climbing moves (which I’ve learned to be cautious with), and during some more common daily maneuvers.
Anyone willing to try the “heel pivot” thing described in #4, and tell me what it feels like for them?

I hope everyone has a good week, and gets at least a tiny bit closer to their goal.
 
We got a nasty storm here. 45 mph wind caused snowdrifts everywhere. A lull allowed me to do some snowshoeing yesterday, and I probably will do some today (after a lot of snow shoveling). It is sunny and cold (teens) today. Tomorrow, I have a PT session in the morning. It takes me 50 minutes to drive there. I'll stay in town, and will go to the rock climbing gym in the afternoon.
I'm still using an ace elastic bandage for some pressure on my knee at night, and it really seems to help.
 
This was on a very good morning, after a bit of warm up stretching. Most important was that I didn't do anything hard the previous two days, so the internal swelling was less than my usual. My left hand index finger is pointing to my hip/trochanter. I don't care much about the "number," but I care how close I can get my heel to butt, because that determines how high I can step.

I've been "working" extra hard on getting the largest range of motion that I can because rock climbing depends heavily on being able to take a high step and then move your weight on to that leg.

I'm not sure what angle this is in this picture, but it is a bit more than I've ever achieved at the therapists office.
That is because the day I go to PT, I've usually done a workout or hike the day before.



[Bonesmart.org] Getting back to hiking and climbing.
 
DIYSteve said:
Wow, flexion looks great. I doubt I'll ever get close to that.
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I figure that we aren't doing the moguls, but what happens (skiing) when you are in a semi-tuck position and need to absorb a roller or other bump. Is it a quick pulse of pain as your legs rise up? I still haven't been downhill/resort skiing yet, and will likely wait till next season. I'm a bit nervous about that, and I want the extra 7 months to build up my quads more. I've got "bird legs" at the moment. Yours seem heavily muscled from what I've seen/read.

I've noticed that you are one of many who remark about the feeling of extra "stability" of your new knee. I don't think I'm in that category. Maybe when they chose our spacer size, they rounded up for you and rounded down for me. That would explain me having more ROM, but more pains and a bit of looseness. I'm hoping my ligaments will shorten with time, and tighten things up a bit without losing ROM (fingers crossed here).
Could you flex your leg pretty well before the surgery? I had early coaching and spent a few months before surgery (like every morning) working my way back to being able to sit on my heels. If you were limited for years before surgery, I assume that it would be a much tougher job to get flex that you haven't had in years. But, it still seems very possible. That situation might account for those people who continue to gain flex for years after surgery.
 
rustic said:
I figure that we aren't doing the moguls, but what happens (skiing) when you are in a semi-tuck position and need to absorb a roller or other bump. Is it a quick pulse of pain as your legs rise up?
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I am a relatively upright skier, which is possible with modern ski technology. (I can talk for hours re ramp angle and forward lean.) I started skiing moguls a month ago, although I pick my way down, never faster than 20mph in easy bumps, usually <15mph. Old man skiing! Today I (lift-served) skied my ultralight spring/summer touring skis and boots, topped out at 41.3 mph max on long runout with good viz. Yeah yeah, I shouldn't be skiing that fast on ultralight gear.

rustic said:
Your [legs] seem heavily muscled from what I've seen/read.
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That's a fair way to put it.

rustic said:
I've noticed that you are one of many who remark about the feeling of extra "stability" of your new knee.
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Yup, my new knee feels rock solid. It may well be partly because my OS preserved my cruciate ligaments, which is relatively rare. (Most TKR surgery involve sacrificing one or more cruciate ligaments.)

rustic said:
Could you flex your leg pretty well before the surgery? * * * If you were limited for years before surgery, I assume that it would be a much tougher job to get flex that you haven't had in years.
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My pre-op flexion was limited to 105 due to bone spurs. I haven't been able to do a deep knee bend since the mid-1995s. My OS said pre-op ROM is the best predictor of post-op ROM, and I seem to be going to form. My current flexion is about where I was 2 years pre-op, although now without the pain. I'm optimistic that my flexion will continue to very gradually improve for awhile, maybe to where it was 20 years ago, although it'll take time.

FWIW, my OS discussed the pros and cons of cruciate ligament preservation. He said preserving could prolong flexion progress and could result in a bit less flexion long term. After weighing the pros and cons, I asked him to try to save them -- and I'm now glad I did. I'm a big guy who does little guy outdoor stuff, and figured I could use as much structural support as possible. ETA: I was aware that some sources recommend against retaining the PCL.
 
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rustic said:
OMG. This adds a bit of optimism about capabilities after TKR, even though I'm probably not going to resume running seriously. I hope this link works.
https://www.uphillathlete.com/new-knee-running-again-total-knee-replacement/?utm_source=Newsletter&utm_campaign=79ead96636-Ice+climbing:+grip+and+lock+off+(NL)_COPY_02&utm_medium=email&utm_term=0_d4dbbfc70b-79ead96636-162995733&mc_cid=79ead96636&mc_eid=551b7486e3

@DIYSteve what do you think about this?
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Cool. Years ago, I met and ran for a few hours with a fellow ultrarunner who runs a half dozen 50ks a year post-TKR. He is a wispy guy, 80 lbs. lighter than I am. My running days are behind me. I suppose if I weighed <175 lbs. I might consider running again -- but I haven't been that light since 8th grade!
 
DIYSteve said:
@rustic, good news. Sorry to hear you have insufficient snow for skiing.
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That situation has suddenly changed! Flagstaff got two feet of snow in town. I live in the country, and parked my vehicle half a mile away from the cabin, because I need to be on the other side of an area that gets bad drifts. We are snowshoeing back and forth for now (snowshoes are easier to deal with inside a vehicle). Tomorrow, I have to snowshoe to the truck, with a backpack full of clean clothes for town and drive to town for my last (hopefully) physical therapy appointment. This weekend I'll try my x-c skis for the first time this season!
 
Hi rustic, I had a bilateral am 11 weeks out . I was wondering what activities you were doing at 11 weeks
Really want to snow shoe and get on my fat bike.

Can you describe where the mystery pan is again . I have some of this in my mid upper tibia in my left leg. My right is so good I forget it was replaced too ... well maybe I’m exaggerating a bit .

I’m doing aggressive pt twice a week . Was thinking of dropping to once , but I want to maintain my flex and extensions both at 135 and -2 right and 0 left

I too had several sports injuries and all my meniscus was destroyed. Love to get back to backpacking . I’m in Colorado .
 
@Sagetek If you look earlier in this thread, my Dec 9th, 12th, and 19th posts correspond to 11/12 weeks. I was just starting to do indoor rock climbing. It was scary and a bit painful, but I was soooo excited to be back to what I loved and things seemed very promising for the future. My climbing has been a bit better and less painful every single week since then (I climb twice a week).
I stopped the "tough" PT around 8 weeks, after having a couple setbacks. My flex wasn't great back then, because I was always a bit swollen from the PT. We hardly worked on flex actually, because it was adequate in the eyes of the PT. Back then, we were working more on re-establishing neurological pathways, coordination and balance. I like really hard challenges, and it was very hard. I took a couple weeks off, and then switched to a PT that I've used on and off for years (for other problems). I continued seeing him until last week. He had a different approach, and it was at his office that I started making good gains on flex. I think that pic above is about 140º.
As for "mystery pains" : at 11 weeks, the inside (medial part) of my knee really hurt if I pushed the inside of my foot against something. Scuffing dirt back into a gopher hole hurt. Frog kick swimming (like when you do breast stroke) hurt. etc. That was just a very sore medial collateral ligament. It got better.
At your stage, expect to have various pains come and go. Actually, I remember having tibia pain back then. It felt like bone pain, and I figured it was from driving that huge anchor into the marrow. It went away, but I still get the bone ache once in a while. It reminded me of pains I had during growth spurts as a kid.
I have one long lasting mystery pain. It hurts in the center of the main joint, which seems weird. It happens when I try to support my leg in the air sideways, and then flex and extend the knee joint. Like a side karate kick. My present PT doesn't have a clue, and neither do I. But I carefully/gently go through those motions every day, and it is improving.
I love CO! What part do you live in? I've done about 20 of the fourteeners, mostly the more technical ones. A few, like Longs in mid-winter (north face cable route) were mini-expeditions. I mostly go to the San Juans, because they are close.
 
I just finished the 5 month since surgery. I'm very glad not to have any of the more severe problems that I read here on BoneSmart (knock on wood). I have friends here in Flagstaff that recovered quite a bit faster than I am, so I'm definitely not tooting my horn about my recovery. But, I am satisfied so far.

I tried cross country skiing last week, and it hurt more than expected. I was hoping for more time and distance, but turned around after a mile. My main problem was that my über-fit wife wasn't available to break trail (she is sick) and the snow was deep and sticky. Going home, in the packed track I had left, was much more comfortable, since I didn't have to pick my leg up with each step. Turning around on a flat was really bad, because my weakness is still dealing with twisting and sideways forces. No damage done, but I had to take two days off of exercise.

On the "good" side of things, my (indoor) rock climbing is going great. Fewer random pains, taking higher steps, and putting a bit more weight on that leg each week.

Last Friday was my last scheduled P. Therapy, but we had a huge snowstorm (google Flagstaff snowstorm records, for pics). I was able to make it to town, but the whole building where the PT works was shut due to the storm. So, I guess I'm done with PT for the time being.
I hope that I get continued improvement this coming month. I'm looking forward to my 6-month post op appt. with the surgeon.
 
I'm in the middle of my six month of recovery. Rock climbing (indoor) is still going well. It is like a fun form of physical therapy. It is very low impact, since you move so slowly and carefully place your feet. It entails lots of static/isometric holds in various positions, of all four limbs. It provides good motivation for using my leg while in flexed positions.
I'm not doing so well on achieving good extension. I've worked at it frequently for the last month or so, and have gone from around +2.5 to a +1 degree. Still not quite flat, and that bugs me. Very slow progress, but least I'm headed in the right direction. Since I'm giving up running, walking fast will more important than ever. Gotta get that leg straight to walk really fast. Achieving a minus one (small amount of hyperextension) would be better, since that is what my healthy leg does.
My extension problem isn't due to tight hamstrings. I can do a good forward bend at the hips, reaching well past my toes with my hands. But, in any position, when I try to straighten my knee that last degree or so, it hurts right inside the joint. There is nothing that I can touch on the surface that elicits this pain. I can only take about 5 seconds at a time.
 
I had my six month followup with the surgeon today. The good news is that the x-rays look good. My joint isn’t lax when they try to bend it sideways in various position. My flex is great (still hanging in there around 140º on good days). I can rock climb with minimal pain, and I do the stairs really well without any pain at all.

But, I have plenty of problems! I still don’t have complete extension, and working on it hurts a heck of a lot more than working on flex did. I’ve got a really bad, deep, pain in the vicinity of the “post” which is in the center of the whole joint, where they removed the ACL and PCL. Twisting motions and sideways forces elicits this pain (this is why I couldn’t ski). I have an IT band problem, which is hurting at my hip. Pain in/near the medial plica is bugging me on my walks. My knee still swells up after some activities, so I have to ice a couple times a week.

OS and I are most worried about the unexplained deep pain, getting full extension, and the fact that the quad on the operated leg is atrophied. We formulated a plan of attack, and I’m seeing him again in three months, rather than waiting 6 months for the one year checkup.
 
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