TKR How much have your quads recovered?'

[pdx]

These are incredibly short followup times -- one month for one study & six months for the other. There's a fly-by line in the first study that notes patients are BETTER OFF than they were pre-op at longer follow-up (33 months), though not as strong as healthy matched controls. That means people who have no knee issues to begin with.
So, it depends on your starting point, it appears, and for how long you measure.
I also suspect few people exercise as much as you do, healthy or not. (Good for you!) Also, none of the participants in the six-month followup had BMIs >35, but their weight was on average higher than the controls and on average they were high-overweight, approaching obese. And they were a bit older. Lots of variables.
I'm delighted to be able to walk up and down stairs pain-free. I can't sit on my heels, but then again, I couldn't pre-op, either! I swim & bike & walk without pain.
You're doing really well. I hope knee No. 2 proves equally successful.

 

[willib]

Tomorrow is time for LTKR, or as I like to say bionic knee #2. I had my last workout this morning on the elliptical plus a round of weights, leg presses and squats which completes recovery #1. My first bionic knee was in mid Sept. I feel extremely fortunate that my first recovery was much better than I expected with minimal pain, good ROM early on. My new knee feels better and the leg is stronger than my soon to be ex-knee. I'm keeping my fingers crossed that I get lucky again. I'll also give credit to the doctors at Mass General who definitely know what they are doing. Practice must make perfect. My doctor is doing at least 3 TKR and maybe 4 tomorrow and he often does this twice per week.

Next week the workouts will revert to taking it easy, lots of ice, oxycodone, maybe some ice cream, and binge watching something on Netflix.

 

[willib]

Tomorrow is time for LTKR, or as I like to say bionic knee #2. I had my last workout this morning on the elliptical plus a round of weights, leg presses and squats which completes recovery #1. My first bionic knee was in mid Sept. I feel extremely fortunate that my first recovery was much better than I expected with minimal pain, good ROM early on. My new knee feels better and the leg is stronger than my soon to be ex-knee. I'm keeping my fingers crossed that I get lucky again. I'll also give credit to the doctors at Mass General who definitely know what they are doing. Practice must make perfect. My doctor is doing at least 3 TKR and maybe 4 tomorrow and he often does this twice per week.

Next week the workouts will revert to taking it easy, lots of ice, oxycodone, maybe some ice cream, and binge watching something on Netflix.

LTKR is done. Came home after 1 night at the hospital. Had one glitch that fortunately fixed itself. The morning after surgery I couldn't wiggle my foot at all, i. e. dropfoot. Toes wiggled a bit, but no control to pull up foot. Caused a bit concern, enough that surgeon and his fellow stopped by several times. PT helped me get up to walk a bit. Unwrapped ace bandage and removed ice wrap. I could get around with walker but had to concentrate to lift foot high enough. PT thought she could see some muscle twitching so was optimistic. Sure enough in the hour after trying to walk a bit it came fully back. They weren't sure if it was just a delay in the spinal block going away or to much compression.

Now I'm just resting, leg elevated, iced and watching football. Rom is about 105 and close to zero. Taking oxycodone per schedule so all manageable. Took a short walk with crutches down the apartment hall. As noted by many, one gets tired easily.

Looking forward to what I hope is as good a recovery as the last one.

Sent from my SM-G935V using Tapatalk

 

[Celle]

Welcome to your second recovery.

I'll post the recovery articles for you again so you don't have to scroll back to them:

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

the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy​

5. Here is a week-by-week guide for Activity progression for TKRs


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.

 

[willib]

Day 6 update. I really can't complain. My first recovery was far better than I had hoped and this one is also going well. Pain is very manageable, never more than 3-4. I'm taking 2x5mg Oxycodone and Tylenol every 4-6 hours starting around 6-8PM which helps a lot with sleep. I wake up in the early AM hours and take my next dose and go back to sleep for another 3-4 hours. During the day, I cut way back. Today I went 8 hours today without anything and then took just 1 5mg dose.

ROM is enough that I can pedal a stationary exercise bike. Pedal is a bit of a strong word, I make the pedals go around very slowly. I like pedaling more than most other stretching exercises since I can focus on max bend and full straightening at the same time. I can stop and full straighten the leg or slide my rear end forward a bit and work more on bending. 5 to 10 minutes on the bike feel like I've done something. I get on the bike 2-3 times a day.

I get around the apartment with 1 crutch and take short walks down the apartment hallway using two crutches. I can walk a very short distance without crutches, but my form is awful. PT prefers that I use crutches and try to walk correctly rather than just limping around.

Other than that, using the Breg ice machine for 3-4 hours per day and for the first 3 hours when I go to sleep.

 

[SusieShoes]

You are having a model recovery! My mom rehabbed her knees almost solely on her stationary bike. Swears that's the best way to do it.

 

[willib]

It is now 2 weeks and it continues to go well. Reducing pain meds to 1 5mg oxy as needed. Mostly use it at night when trying to sleep. Yesterday I drove for the first time, I just make sure I haven't taken any pain meds in 4 or 5 hours. I started going back to work 1/2 time, showing up late, leaving a bit early. I have a desk job so I can find ways to sit and elevate. I bring a crutch to work, but don't use it most of the time. Today I used the stairs for the first time. We had a fire alarm in our apartment complex and we had go outside until fire department shut it down. We are on the 4th floor. I was pleasantly surprised that I could go down and up fairly smoothly using the handrail. Monday I start outpatient PT. Compared to my first TKR I would say that some aspects are going better. In particular, my quads have been stronger earlier in the recovery. After the first one, it took more than a week to be able to do leg lifts, i.e sit on bed, lift leg and swing on to bed. I had to help it with the other leg. This time I could do it on day 1. After the first TKR when I tried using my quads it would tighten hard a few inches above the knee and hurt. It took several weeks for that tightness to diminish. This time it seems ok much sooner. Not sure why, but I'm not complaining.

I have not been doing very aggressive PT. Since everything has been going well, ROM is decent, strength is good, I am mostly resting my knee and letting it heal as has been advised on this site many times. I still get tired earlier than usual and find myself in bed icing the knee by 7:00 PM. The last 2 days has been a bit better in that regard.

 

[sistersinhim]

What a great recovery you are having! And you are doing it smartly. Good for you!

 

[willib]

I am at 4 1/2 weeks after 2nd TKR and continue to make good progress, better than anticipated. I stopped taking any Oxycodone 4 days ago and only use Tylenol or Advil if needed. I also stopped all the other drugs to battle oxycodone side effects, stool softener, laxative. I also stopped aspirin as a blood thinner. However, I was a bit surprised to have some Oxycodone withdrawal symptoms since I had been taking only small doses. I had only been taking about 2-3 5mg doses per day, mostly at night before going to bed, once in the 2-3 AM and maybe once during the day. However, I noticed that for about 2-3 days after stopping I would occasionally feel poorly with some chills as if I had a mild flu or feeling a bit run down. These were not major symptoms, but a bit annoying nevertheless. Today, which is 4 days after stopping I felt completely fine.

I restarted official PT after the holidays, stationary biking, stretching, bench squat with zero weight and icing. I am also back in the gym, on the elliptical for 10-15 minutes, stretches, and leg presses. My right leg which had RTKR on Sept 11 is doing quite well. With just my right leg I can do leg presses that are slightly more than my body weight, 210 pounds. This is about 20-30% more than 1 month ago and almost double what I could do after 4 weeks. I have just started light weight training with my left. I am taking it easy and doing the minimum weight on the leg press machine. I think that by this weekend I can step up the gym work and do some stationary biking or elliptical that will also be decent cardio.

My 5 1/2 week checkup with the ortho surgeon is next week.

 

[SusieShoes]

Good to hear how well you’re doing! Sounds like you warded off the nasty oxy withdrawal. Yeah, I had that too when I quit it. You just wake up one day and think, “Glad that’s over!”

Please don’t overdo the weights and leg presses this early on. I only say that because my surgeon specifically told me NOT to do leg presses. He said they were bad for knee replacements early on. Be careful. The cardio training is really good and I hope you have great fun getting back into it.

 

[sistersinhim]

Squats are also bad for a tkr. Be very careful with those. Your knee is still an infant.

 

[kneeper]

Even though your right knee is "older" think in terms of gearing your exercise to the new knee--not just the potential pain but the energy needs of the recovering body.
I think the exercise bike is a good option, but you really have plenty of time to get to building muscle so personally I'd wait on the leg presses. The tissues around the knee are so sensitive for the first months. You usually don't know you've overdone until after the fact and then you pay for it. Just because you "can" do something doesn't mean you should. Listen to your body and be cautious.

 

[willib]

I asked my ortho about what exercises I could do and if there were any I should avoid. He said that I had no restrictions. I asked specifically about leg presses and he said they are fine and encouraged them. He recommended staying away from open chain exercises such as seated leg extensions, at least with heavier weights. Basic message was that if I had problems such as swelling or pain during or after exercising that I should back off. That's been my guiding light for PT and going to the gym. Fortunately, it has been easy to tell what is and isn't a problem. I haven't had any situations where the exercise felt fine and then it swelled up later. I will see my ortho again next week and will ask these questions again just to be sure.

 

[kneeper]

If it's working for you and you aren't noticing ill effects then so be it. Most people find some of these a bit much this early but think they should "power through" even if they suffer from it. That's why we like to advise caution.

 

[Space Knee]

I am at 10 weeks post-op from LTKR and a couple of weeks ago I was okayed for whatever i wanted to do except swimming (incision is still healing). I have to admit that I've had very few problems with the stationary bike and find it quite enjoyable. In fact, it warms up the knee so I can do a few gentle stretches, etc. afterwards. Walking, of course.

It sounds like you are getting along really well! Congrats!

 

[GottaDoIt]

@willib
I too was surprised by the loss of strength in my quad muscle on my surgery leg, thinking I had good strength before surgery from walking and swimming on a regular basis. But what really surprised me was the pain and discomfort on the side of the upper leg, up to the hip and lower back ever since surgery back in August 2017, which I think was because the surgeon also 'straightened" my leg, which had become bowed and out of alignment from the arthritis. We worked on this issue towards the later part of the in-office PT sessions and I continue to walk and stretch the area everyday to help strengthen and gain the flexibility back. I just passed the 5 month mark since surgery and feel it probably will take time to get the muscle group to realize where it is now is where it should be and not revolt to change. I also introduced leg presses on a limited basis, since we had done these in the PT sessions and they actually feel good; a little knee stretch and strengthening at the same time.

 

[willib]

It's now a bit more than 9 weeks since my LTKR and 4 1/2 months since my RTKR and I really have nothing to complain about. I was off pain meds after 4-5 weeks. Occasionally I take an Aleve but usually not more than once or twice per week. It's not as if I was 20 years and never think about my knees, but I can do things I haven't done in 4 or more years. I know my knees are bionic, but it is much better than before. I can now go down stairs like a normal person. It's probably been been 3-4 years since I could do that. I can walk any distance to lunch and not plan it as if it was an expedition up a mountain.

I'm ramping up the intensity in the gym 30+ minutes on elliptical, bench squats with increasingly heavier weights. Wall squats with a ball on my back and leg presses. I can tell when I'm pushing my knees and keep the level below that. I'm still icing my knees for 10-15 minutes after a workout.

Things that are still weak or difficult include leg curls. Hamstrings are still way below par and adding too much weight causes pain down the side of the knee into the lower leg. Its getting better in the last 2 to 3 weeks, but it still has a way to go. My balance is also quite pathetic. Exercises such as balancing on 1 leg make it seem that I'm drunk. Balance gets worse as you age, but TKR makes it even worse. I'm doing a variety of 1 legged balance exercises including using a Bosu ball. I have started 5 to 10 minutes of slow jogging on a treadmill, something I haven't done in 10-15 years. I don't plan to do a lot of running, just enough so I can cross a street quickly and not get hit by a car. I'm finding the few minutes of jogging helps my balance.

Kneeling continues to feel weird and ROM is around 125. Maybe it will get to 130 if I keep at it.

In a month or so once the weather improves, I hope to get back on my road bike and start to rebuild my cardio. I'll also step up quad exercises in both the gym and bike with hi-intensity sprints. By this summer I hope to have matched or exceeded my pre-surgery bike fitness and not have any pain walking around.

For anyone who is continuing to postpone TKR like I did for years, my story may be helpful. I was high functioning going into surgery. I could ride my bike very hard. I am a MAMIL, Middle Aged Man in Lycra. I did a several mountainous century rides each year and could crank high power while riding with the fast guys in my club. However, walking was literally a pain. 20-30 minutes would cause my knees to swell. Planning a walk in town with my wife required careful planning on where to park and how much to walk. Going down steps was an ordeal. Nobody asked me to carry anything down stairs since I had to hold on to the handrail. This had a significant impact on any vacation plans or weekend plans with my wife. I kept postponing surgery because for whatever reason I could still ride. Now that TKR is behind me I have no fear of walking. We are planning vacations where we will likely walk all day. I am very glad to have finally turned bionic.

 

[Jamie]

@willib ... congratulations on your sterling recovery from your TKRs. Yours is a great story to read and should offer hope to a lot of our more athletic members who want to get back into action after knee replacements. You've taken a good approach to recovery....testing and not pushing when you experienced any pain or swelling following activity. That is the bottom line of what we advise here.

Sadly, most people cannot go quite as quickly as you in recovery, so I will caution others who may be reading your story that they must listen to their bodies when adding exercises. If there is ANY pain during the exercise or swelling up to 48 hours afterwards, it's too soon for whatever you're doing.

I also commend your therapist for not pushing you and for insisting that you not take pain meds right before a session so he could properly ascertain your pain levels during your time with him. I so wish all therapists would realize that is the proper way to rehab a knee!

Don't worry about your quad strength. It may take some time, but it will come. There is no reason for it not to! I noted those studies you quoted much earlier in your thread were very old. Lots has changed in the world of knee replacements, so just disregard what you read there. Current science is on your side for many wonderful years ahead with those great new knees!

 

[Arttie]

"If there is ANY pain during the exercise or swelling up to 48 hours afterwards, it's too soon for whatever you're doing." Last Sunday I had finished up removing an old and installing a new dishwasher, honey do project. I was slightly swollen and sore after and had to ice for a couple of days. I won't be doing that again anytime soon.

 

[willib]

@Arttie I hope you won't be installing a new dishwasher again anytime soon, that would be a real bummer.

One of the side benefits of TKR and PT is that it is providing some quality family time. My son tore is ACL last year skiing and just had it reconstructed last week. He is staying at our house for a few weeks while he recovers. We both get to go to same PT at the same time. Nothing like father son physical therapy sessions to provide opportunities for bonding. Plus I can point to my knees to show what will happen to him if he continues to crash and burn on a ski slope.