HerbM: Here We Go Again, Bilateral TKRs for late October/early November

[Jamie]

Studies have not shown a direct correlation between physical conditioning prior to surgery and an easier recovery. However.....it cannot hurt you to do as much as you can to strengthen your muscles (both upper body and quads) prior to surgery. The key is to not do any exercise with your knees that results in pain. You want the knee joint with the least amount of inflammation as possible on surgery day.

Sadly, no one can predict who will have an easier recovery and who won't. The good news is that proper pain management for those first few weeks and months can make things much more comfortable if pain is present. So please try not to worry about this.

In attending surgeon's conferences, I've heard some talk about their belief that a person might not have more ROM after surgery than they had before. But....even at the same meeting, another surgeon will stand up and say just the opposite. I know we've had members on BoneSmart who have achieved excellent ROM following surgery. While this is obviously a goal, the primary purpose of a knee replacement is to restore a person to a more comfortable lifestyle where pain is gone or at least minimized.

The knee is such a complex joint with many factors that impact how well the new joint will function. It is more than just a "hinge joint" and surgeons sometimes must do some fairly complex balancing of the soft tissues to achieve optimum function. A really good surgeon may do this very well. One who does fewer of this complex surgery may not. This is why we really stress the experience of the surgeon in knee replacement surgery procedures as the most critical factor for success.

 

[wolf woman]

@HerbM After reading your posts, I simply had to toss in my two cents, so here we go.
You might consider asking your surgeon if you will be supplied with an ice pump after surgery. These little primitive machines bring about great things for reducing swelling and pain. Since you are having both knees done, consider getting two. Actually, I own two, but only use one. If the hospital doesn't supply it, order them. Or, you can do as I did and purchase from CraigsList. I paid 20 bucks for a 150 machine, and it's better than the new one I bought for 110. Then you will need to be sure you have ice makers that can accommodate two pumps. You can find hints of things to freeze to assist with that.

My hats off to ya for having what it takes to go for two at once! And, I strongly urge you to go to rehab at least until you know you can navigate to the bathroom without falling.

Another thing from my perspective is having a truck that sits high enough to get in and out of without pain. My legs are super long, so that was important. Think about it.

You have a huge support system here, I am glad you are taking advantage of it. Oh, and totally off the subject, are you by chance an engineer?

Mary

 

[HerbM]

Ok, I have just begun a (quick) review of studies on pre-op vs. post-op ROM, and no definitive conclusions should be drawn from my very limited research, but in the few articles I have read the following seems to be pretty close to the consensus:

Does pre-operative flexion factor influence the post operative range of motion in total knee arthroplasty
Ganesh Babu Natarajan, Veera Ram Narayan, Vijayaraghavan
6-Jun-2014
Department of Orthopaedics, Sri Ramachandra Medical College (SRMC), Porur, Chennai, Tamilnadu, India
https://www.jotr.in/article.asp?iss...=7;issue=1;spage=78;epage=83;aulast=Natarajan

"Results: The mean pre-operative flexion was 85° and post operative mean flexion was 115°. Obesity is associated with poor flexion after TKR. Knees with Rheumatoid arthritis started with a lesser flexion (80°) than those with Osteoarthritis (90°) and the change in flexion score has shown a significant difference of 40 and 20°, respectively. Average post operative range of motion for patient with pre-operative ROM <90° was 110° flexion, whereas in patients with pre-operative ROM >90° flexion, the average post operative ROM was 120° flexion. This shows, the gain in flexion is more in patients with <90° than those with >90° pre-operative flexion.
Conclusion: Yes, the pre-operative flexion significantly influenced the post operative flexion and it is a good parameter for predicting the post operative outcome." [RED highlighting added.]

Another study was very explicit when claiming it a) pre-op ROM made no difference but then divided the study into cohorts, it claimed that b) those with less than 90 degrees pre-op would tend to INCREASE, and those with more than 120 degrees would tend to decrease (or perhaps stay the same.)

 

[Jamie]

Yep....that's what you're going to find....studies to support both opinions.

 

[HerbM]

@HerbM
...consider asking your surgeon if you will be supplied with an ice pump after surgery...
...be sure you have ice makers that can accommodate two pumps...
...urge you to go to rehab at least until you know you can navigate to the bathroom without falling....
...having a truck that sits high enough to get in and out of without pain...
...are you by chance an engineer?...

Mary

Thanks Mary -- I obtained one of the Arctic cold therapy machines for my THA (asked for it even though the surgeon doesn't typically order them for hips) and it was indeed virtually worthless without a large supply of IN HOUSE ice. (I used my 4 freezer knees packs almost exclusively.)

However, I now have a 5 cubic foot "small" freezer chest on order and we'll use that to freeze 'tupperware' etc. ice and then keep it because my wife really would like more freezer space in any case.

My goal is to obtain at least one more of the Arctic machines and/or the Y-adapter with extra hose (preferably both.)

My current plan is to go to rehab following the BTKR -- however, when I attempted to pre-arrange this the rehab indicated that it might take THREE DAYS to get from surgery to rehab and by that time I expect to have a good chance of being comfortably at home.

I am NOT going home until I can comfortably navigate and get up/down from toilet and chairs without another person assisting. My wife is in no condition to provide much assistance (discussed above) of this type.

However, I am going home at the earlier opportunity WITHIN those constraints.

Yes, I am something of an engineer, mathematician, and computer scientists (sometimes self-taught however) with a very practical but scientific bent.

 

[HerbM]

Yep....that's what you're going to find....studies to support both opinions.

Actually 'that' is NOT what I am finding (so far). Most everything is leading towards better pre-op ROM indicates better post-op ROM. That one study that found their was little difference was old and my point in mentioning it was that even then it showed a distinction between those with rather large pre-op ROM vs. restricted pre-op ROM.

From what I am reading, pre-op ROM is a GOOD THING -- I have however found no studies so far that discuss whether IMPROVING pre-op ROM (as opposed to just taking what you have to surgery) makes any difference.

Even if there is a significant difference based on pre-op ROM we wouldn't know if WORKING to improve that immediately pre-op would increase that correlation.

The following article is another interesting one, especially for the athletes and those with significant will to succeed,
WHICH PRE-OPERATIVE FACTORS PREDICT KNEE RANGE OF MOTION DURING STAIR WALKING AFTER TOTAL KNEE ARTHROPLASTY?
broken link removed: https://www.bjjprocs.boneandjoint.org.uk/content/92-B/SUPP_III/424.2
"Learned helplessness was a significant predicting factor for stair descent" and BMI etc. made a significant difference in some measures as well."

Based on this, being fit and having a fearless attitude can be quite a benefit.

Someone like @CanukTriMom or @Me2 or perhaps me* is going to stand a good chance of improving ROM quite a bit.

*Note: My BMI is not particularly low -- there are two reasons for this: One BMI doesn't always give meaningful results for those with a lot of muscle mass and big bones (I literally have both) and I am DEFINITELY somewhat overweight. (I still come in under 'obese' but my BMI is a bit misleading if taken in isolation.)

However, muscle, fat, or bone, my knees are going to be required to HAUL all that weight around no matter the composition.

 

[wolf woman]

@HerbM Also keep in the back of your head the possibilities of bringing in a hospital bed with the trapeze overhead if you don't stay in rehab long. The insurance should pay. I have articulating beds at home and they have been life savers. My message therapist loved that the foot of the bed came up so high that I didn't kill her back. Mary

 

[HerbM]

@HerbM Also keep in the back of your head the possibilities of bringing in a hospital bed with the trapeze overhead if you don't stay in rehab long. The insurance should pay. I have articulating beds at home and they have been life savers. My message therapist loved that the foot of the bed came up so high that I didn't kill her back. Mary

I am not opposed to this idea -- however there is no room in my home for that so my idea was a bit different.

Earlier in this thread, I posted the basis for the design of a pull-up bar/trapeze that would and was told by several experienced people this wouldn't be necessary.

For $50 bucks each and a small amount of work (plus some additional benefits having nothing to do with the BTKR) I decided to ignore such advice and build the frame anyway.

One frame will go above and around my power recliner (which I also bought specifically with the BTKR & THR in mind) as well as my over-bed table I use with the recliner. (One of the advantages is that the legs on the frame will help me with computer etc. power cord management and the tracking of the over-bed table close into the recliner.)

I am keeping the over-bed table when this is over so I may keep the frame as well.

The frame can also be use not just for assistance in rising or sitting, but as a built in exercise bar to allow me to work both my upper body and by supporting my weight partially my lower body as well. My Meridian trainer encouraged me to use is this way.

Beside being easy and cheap to obtain, designing and building it was fun. (I may or may not build the one for the bedroom -- haven't bought the materials for that one yet.)

 

[Roy Gardiner]

It seems to me if pre-op ROM is poor due to mechanical defects (malalignment, osteophytes or bone spurs, etc.) then removing all those issues could easily obtain a better post-op ROM and there would be no reason for my first surgeon to say, 'We hope not to lose MUCH ROM during the replacement.'

I think this's been discussed before? Whether or which, my own experience is improvements to both extension (from the first moment I stood up!) and flexion (still slowly improving) and legs straight rather than bowed. I see no reason for the doctor's statement and would like to know his reasoning.

 

[Poppet]

Wouldn't it be great if we all had that 'crystal ball' that tells us our exact outcome following complex surgery.. we don't and neither does the surgeon!

We do our best to prepare, have the surgery and then embark on our recovery journey!

We can't predict the future.. we just plan and hope for the best!

 

[CanukTriMom]

@HerbM

I can just envision you swinging from a trapeze in your room......especially while executing those martial arts moves here and there... If you go that route, please post pics!!!



Cheryl

 

[HerbM]

@HerbM

I can just envision you swinging from a trapeze in your room......especially while executing those martial arts moves here and there... If you go that route, please post pics!!!



Cheryl

You are having WAY TO MUCH FUN with *MY* surgery.

It's really more of a "high bar" (pull-up bar) with planned ropes that will hang down for me to grab to pull up to the bar itself -- the ropes MIGHT be called a trapeze.

 

[jeano]

Speaking of improved flexion, I have apparently picked up another 9 degrees in my left knee since leaving PT for that'un. I'm 100%sure my right knee wasn't a lot better than the low 120s the week before surgery and today, 14days post op, its at 121. I wouldn't mind having matching 132 degree knees.

As I tell people at PT, I'm satisfied if I can stand on one foot in the shower, cross my ankle over my knee and scrub the bottom of my foot. ROM is all well and good but i'll trade a few degrees any day for improved stability and decreased pain.

 

[kneeper]

There are so many factors involved with our individual knees and soft tissues I can see why it's hard to predict.

 

[Poppet]

So true @kneeper - I am sure if we did a survey, for both THR and TKR's no two recoveries would be the same x

 

[HerbM]

Our little freezer (5 cu-ft) arrived yesterday and though we haven't set it up yet, it looks to be ideal for our purposes. First to supply ice for the cold therapy machine(s) and then to provide extra freezer space in addition to our regular refrigerator/freezer which always seems to be overflowing.

Funny thing about the arrival though. My wife came back from a trip to take care of the grand twins over a long weekend, entered through the garage (leaving the door open), and went to handle a few things (bathroom etc.) before returning to bring in her bag from the car.

In the short interval the shipper had not only dropped off the freezer without (apparently) knocking or notifying us but had put it IN THE GARAGE.

 

[CanukTriMom]

Well that shipper obviously knows who you are!

 

[Poppet]

Was anything missing - not that I am the suspicious kind Herb, @HerbM

 

[Maeve]

Oh my @HerbM ! I am almost mesmerised reading your posts. Almost like preparing for a space mission!! It's very interesting to me ...as an ex hippie on this forum, and now lining up for a LTKR on Oct 9...how different people approach their op and recovery!
I can see the military training coming through in your posts .
Me...I'm a bit of a Type A personality and like to control but in the case of this little project I figure I have sourced the best possible surgeon, the best possible private hospital and adjoining rehab facility ( well it proved so for the hip!) and planned for the following physio...for specific muscles that haven't responded as well as hoped during the rehab period..and then a month of exercise physiology ( hydro etc).
Plus ensuring the daily coffee runs will be on schedule including my husband's golf days!
Hey..I'm beginning to sound like I'm also preparing for lift off!
All the best!

 

[Maeve]

I'm with you @jeano! Stability is my main aim!