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TKR Greatday6's recovery thread<

Greatday6

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Hi, I’m feeling a bit overwhelmed concerned about stiffness and swelling it is affecting my range of motion.

It’s about 6½ weeks since I had surgery for right TKR. I’m able to straighten my leg without any difficulty, however when it comes down to flexion, bending that’s where I suffer. My flexion is 90. I go to physical therapy 3 times a week. But it seems that I am not making any progress.

The physical therapist is able to manipulate my knee, however, it’s temporary basically for the moment. I’m consistent with doing exercises at home. I’m icing and elevating but, it seems like I’m stuck day after day at 90.
 

kneeper

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90 at six weeks is not bad, particularly with a swollen knee. Focus on getting that swelling down with ice and elevation and very gentle movement and you should continue to see improvement. That's what worked for me.
 

Celle

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Hello @Greatday6 - and :welome:

Please will you tell us the full date of your knee replacement and which knee it is, so we can make a signature for you? Thank you.:flwrysmile:

I think that going to PT 3 times a weeks is too much and letting your PT therapist push on your knee is not helpful either.
It's not lots of exercises you need, but more rest, ice and elevation of your leg, to help decrease the swelling.

Your knee won't bend much further until you get rid of the swelling.
So cut back on the exercises and increase the amount of time you spend resting, icing and elevating.
There are articles about the best way to ice and elevate in the post-op reading I'll give you.

Complete recovery from a TKR is going to take a full year, so you have plenty of time.
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

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 ROM is there right from the start, just waiting for all that to happen, so it can show itself.

Now, here is your recovery reading:
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
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
5. At week 4 and after you should follow this
6. Access to 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.
 

grandma chris

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@Greatday6 you're actually doing quite well for six weeks. One of the Advisors will be along shortly to give you all kinds of reading - do read them, they are amazingly helpful. I had a right knee replacement six months ago and I followed the Bonesmart method of recovery. I had an excellent recovery.
 

winemama

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Because of the pain in my ankle and calf , because of the leg straightening, I’m four weeks out and I’ve had no PT. And I’ve been doing fine I’m at 90 just with me walking and doing the exercises they recommend. The swelling is reducing and I feel I making great progress. My first knee replacement 16 weeks ago I was obsessed with numbers, but after finding this blog I realized I was putting to much stress on myself
 

Josephine

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I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
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Greatday6

Greatday6

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Sure you can ask me questions, Josephine.
 
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Greatday6

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I would like to thank everyone who responded to my post yesterday. I appreciate the information provided.
It eased my mind to hear from individuals who have gone through TKR and or a revision.
Thank you.
 

Josephine

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Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
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Greatday6

Greatday6

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1. Level of pain 3-4 soreness, aching, stiffness and swelling. I tend to have a high tolerance towards pain.

2.Pain medication prescribed :
Lyrics 50 my 1 daily- end 5/1/19
Celebrex 100 mg 1 daily end 5/24/19
Oxycodone HCL 5 MG tablet take 1 to 2 tablets every for hours as needed moderate to severe pain.
I only take 1 tablet of Oxycodone ½ hour before Physical Therapy. That's usually when I have the most pain.
Tylenol Extra Strength 500mg 2 tablets 2x a day

3. Moderate swelling

4. ROM Flexion- 90 Extension- +10

5. Ice knee for 20 min 3 times a day.

6. Elevate knee 20 min 3 to 4 times a day.

7. Activity level- fold laundry, load dishwasher and unload, feed the dog and prepare dinner.

8. Exercises at home 3 times a day
Seated static chair scoot 10 x3 set
Seated gastroc stretch 15 x1 set
Long sitting quad set on couch 15 x1 set
Standing bilateral calf raises 15 x1 set
Supine straight leg raise 15 x1 set
Supine ankle pumps 10 x1 set
Hook lying glute sets 10 x1 set
Side lying hip abduction 20 x1 set

PT 3 times a week
Stretching hamstring - 5 x3 sets
Stretching calf- 5 x3 sets
Strengthening quadriceps sets 10 x3 sets
Knee slides 5 x3 sets
Straight leg raises 10 x2 sets
Stationary bike 10 min
Step board 2 x10
Slant board standing in place 30 sec
Leg press 45lbs 30 x1 set
Leg curl 45lbs 30 x1 set
Hip abduction and adduction 45lbs 30x1 set
 
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Josephine

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7 weeks
4. ROM Flexion- 90 Extension- 110
Please explain - it is impossible for a person to have extension of 110! It's either 0 or up to 10. Here is a graph to explain it for you



You can assess you own extension though. It's quite easy:
1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee
a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's +0
d) if you can't get your fingers under at all, it's -5 or more​

As for your flexion, how do you know it is 90 degrees?
 
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Greatday6

Greatday6

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My error, I was advised by the the physical therapist that I am at 90 degrees flexion and exstention +10 not 110. Please excuse my error typo, typing via cell phone.
 
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kneeper

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My PT gave me a whole list of exercises but also told me there was no need to do them all each day. I can tell you I never did 3 sets all at once. I might do 3 sets over the course of the day... depending on how I felt. Several of the ones you list seem to be for strengthening and those can always be picked up when your knee is a bit more healed.

I pretty much elevated whenever I wasn't standing (with some exceptions.) It was more like sit with my leg down for 20 mins rather than elevate for 20 mins. :heehee:
 
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Greatday6

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I tend to push myself a little too much trying to do these exercises, it’s as if I’m competing with myself.:heehee:
 

Celle

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I tend to push myself a little too much trying to do these exercises, it’s as if I’m competing with myself.:heehee:
I'll say!
You're doing far too much in the way of exercises.
Josephine will comment more fully about your exercises, but I must say this - stop everything that uses weights. They can cause damage to your knee at this time.

Your knee isn't lazy or unfit - it's wounded by major surgery and it needs time and gentle treatment, so it can heal. It's far too early in recovery for you to be doing any strengthening exercises.
 

Irish471

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@Greatday6 , I think your ROM at 6 weeks is spot on. I agree with @Celle . I wouldn’t be doing any weights at all. I bet you’ll see a difference in your pain levels and swelling. :)
 

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@Greatday6, I can not contemplate the amount of exercise you are doing. I think of my knee and recovery this way - if say I had broken my leg in several places, in hospital they would have used metal plates or pins to repair it, restricted me to extended bed rest with permanent elevation for a number of weeks, when discharged from hospital I would have had a cast for another month, and only when cast off would physio begin. Apart from the fact that our PKR is a joint that needs to move to help muscles and tendions recover better, why treat it any different from other major leg/bone surgery and try to race through physio not caring what other damage might be happening, then 6 weeks down the line wonder why we are still in pain!
Many surgeons seem to downplay recovery times, describe the op as routine, you might only be in hospital for a day, and do not stress to the patient prior to the op how much trauma will occur (maybe because people may not go ahead with such elective surgery at that point?). We then proceed post-op as if it was minor surgery until we discover bonesmart and learn otherwise.
 

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