How to get best ROM

[Roof1]

Hello everyone,
My husband had RTKR 13 Oct 08. Like most of you here he has had a real challenge coping with the afters involved. Although he has come a long way he still has swelling after exercise (bike mainly) and walking for any time. However his main problem is his ROM, currently about 95. He did get to 100 one day at PT but has not been able to maintain or increase this. Does anyone have any special tips on improving ROM and have any of you had similar problems? Still using ice packs to reduce swelling and help pain. He is a Roofing Contractor by trade and although 63 gets very frustrated with the limitations he has to endure. A couch potatoe he is not and even getting into the garden without the pain at the end of the session would be very beneficial for his mental health at this time. Any help would be very much appreciated......
Sue for Nev

 

[Josephine]

Hey, Sue! You made it! Well done ..

As for your hubby's ROM, sounds to me like he could do with having a manipulation. What's his surgeon had to say about this?

 

[Roof1]

Thank You Jo for all your help.
A Manipulation was mentioned early in the recovery and he is to see his surgeon on Wednesday Jan 14. He does not want to undergo any further "surgery" and having been witness to all that has gone before I cannot blame him one bit. The thought of more pain is just awful. What we cannot understand is why it has not progressed ?? He has tried so hard.
TY Sue

 

[Josephine]

It's not his fault - these things sometimes happen. And a manipulation or MUA (manipulation under anaesthetic) is not a big thing. It goes like this ...

(mini lecture coming up!)

All the structures in the body, muscles, tendons, ligaments, even gut and lungs, need to be able to glide over one another smoothly to let our bodies work. To do this, the body produces a special viscous fluid that acts like the oil in your car engine and lubricates everything with great efficiency.

Now when the surgeon opens up any part of our body, the internal stuff gets exposed to the air which is, by comparison to the body, cool and dry. The natural reaction is that the fluids evaporate and the tissues cool. This can make the organs and structures dry so when the wound is closed, part of the healing process is for the body to go into overdrive, producing extra fluid to replace what is lost. This is one reason why you need IV fluids during and after an operation.

Now as a general rule, 95% of people manage to make up this fluid loss and normality is restored quite quickly. But in the other 5%, for a variety of largely unknown reasons, their bodies are deficient in making up this loss and lacking the necessary lubrication, the ligaments and muscles lose their 'glide-ability' and beging to stick to one another. This is called adhesions. If this happens and the function of the joint is affected, the answer is to work the joint with some force, thereby freeing the structures from their locked-in state. Much as you would if you got a sticky or rusty lock and put some oil in it, you'd work it back and forth to free it up. That's all a manipulation is.

Pain afterwards is only moderate and short-lived. Easily controlled with meds. If you look around on this forum, you'll find several other threads about MUAs which will give you first hand information.

By the way, I just noticed this in the pre-surgery forum so I am moving it into the Recovery Discussions forum.

 

[Roof1]

Thanks again Jo
We will see what Doc has to say tomorrow. I must say that the ROM is slightly improved at the moment, possibly 110 we think (HOPE). I will make a point of looking for the other threads on MUAs.
Kind regards
Sue & Nev

 

[carolinacooker]

I hope your hubby does well. Ongoing right knee problems and injuries over a 20 plus year construction career led to my having to have a RTKR at 39 and giving up what I loved most. Now I have changed to my second love, cooking as a new career. Best of luck, I feel hubby's pain.

Dw

 

[Roof1]

Thank you so much DW your imput and interest. There are so many great folks on this site. The info is just so helpful.
All the Best
Sue

 

[Jamie]

Sue and Nev.....I hope things continue to progress. It is frustrating when you do all the right things and recovery just doesn't go as fast as you would like. We're all rootin' for you!!! Hang in there!

 

[300game]

Roof1 I was only at 72 ROM after 7 weeks. I did not want to go through a manipulation either. I got a Flexionator machine from ERMI. The web site is www.getmotion.com. After three weeks on the machine (2 times a day Monday thru Friday and 3 times a day on Sat & Sun) I went to 112 ROM give or take. I just saw my surgeon this past Monday and he was very surprised that I had gotten that much ROM back in 3 weeks. He said that I was over the hump and would not require manipulation. I plan on continuing use of the machine (and don't forget all of the other exercises too) for at least another 5 weeks. Hope this helps.

 

[kipper]

This might not be any help at all but I got my good ROM while asleep during the night! Doing the usual exercises of bending the knee were fine and I got to around 95 - 100 but then in bed I started lying on my side (of the replaced knee) and bending it slightly to try and get comfortable. After a couple of nights I found I was waking up in the night with my knee bent practically right up to my chest! This seemed to happen while I was asleep. When being measured for the ROM its now about 120 but if I get on to my side the bend is as good as the good knee.

 

[Josephine]

Well, just goes to show how one's mind can affect such things. Obviously the relaxtion and absence of 'guarding' (tightening of the msucles because of anxiety) allowed this miracle to occur! I am very pleased for you!

 

[jacques1]

300game
Aren't those machines expensive. A good friend of mine had to pay, I believe close to
$600.00.

I will keep my fingers crossed that the ROM can be done by by yourself Roof1
Wishing you the best and keep us posted.

Deb

 

[Kevin Finn]

I am 13 weeks out from right knee replacement. A month ago I purchased a recumbent bike to try and increase my ROM from 105+. I went through a lot of pain, but I quickly increased my ROM to over 120. My surgeons nurse told me (after I went over 121 that 120 should be the maximum range). Since doing this, my knee has been swelling (especially the left side, looking down, and my knee feels like it is bound with dry leather straps. No matter what I do, it still feels like it is bound. I can walk for about ten minutes, but them my knee starts to burn and ache. Again, this is thirteen weeks out from surgery. Has anybody had anything like this experience? I sent a letter to my surgeon asking to see and hold the prothesis he placed in my knee. I asked for this just to have a better understanding of how my knee is supposed to work. Prior to surgery, and since surgery, I have seen the xray, but have never had the opportunity to educate myself regarding TKR. My cousin who lives in Redding, California said before his hip replacement, he was shown the prothesis' and the one the surgeon had chosen. He also went to a meeting of patients scheduled for hip surgery pror to his surgery. It seems that all surgeons doing this work should try to hook patients up with a support group to share experiences. Thank God for this web site and the sharing of information. I would encourage those who use the site to make a donation to help defray the costs and to allow for research. Nevertheless, I am very discouraged. I am in constant pain and am tired of the feeling of straps binding my knee. I have seen messages on this site from patients who have had an easy and quick recovery. I have also seen threads where patients are happy and healed. Am I an exception, and if so, what am I to expect?

 

[MarionSt.]

Wow, I feel so much better reading your guys "Posts". I was feeling a little lost as to where I was in my recovery. I am learning alot, and go to the PT today with some intelligent questions. Keep talking...as it really is helpful...

 

[MarionSt.]

I guess my post wasn't very helpful to Kevin's post regarding his ROM. I am only at 110plus with lots of work. I also work out on my recumbent bike, but not to his extent, maybe. Do you use lots of ice. My knee used to feel like a block of wood, when I overdid, but not strappy. HMMMM. I came to this website for help also...so keep reading the other veterans.....

 

[ship4]

Nevertheless, I am very discouraged. I am in constant pain and am tired of the feeling of straps binding my knee. I have seen messages on this site from patients who have had an easy and quick recovery. I have also seen threads where patients are happy and healed. Am I an exception, and if so, what am I to expect?

Kevin,
I have a couple of questions for you.
What brand knee replacement did you have put in your knee?
I have 2 ~ broken link removed: https://www.healthbase.com/resources/orthopedics/knee-surgery-implants/johnson--johnson-depuy-knee-implants_4.html replacements. I had the surgery for both of them on 6/18/08.
Take a look at where the top of the tibia is sawed off, and where they hammer in the "platform" in the picture of the knee system. Is the "feeling" of "straps binding your knee" in this area? (Just below the bend area at the very top of the calf?
This is what I felt the most while healing and people would ask me what it felt like....... I could feel where the platform was resting and can still feel it on both legs if I rub up and down in that area just below the knee bend where the metal platform is located. The feeling of being strapped does go away with time, however, it will always be a platform there which is abnormal from a regular bone meet cartilage meet bone knee. The replacement is the metal platform, plastic spacer that rotates in my situation and acts as the cartilage for the implant fitted onto the end of the femur.
Is this the strapping feeling you are talking about?
I am now 7.5 months out and went skiing again for the first time and actually enjoyed myself and felt like "the old me"! I was cautious, nervous, and excited all at the same time. Now I know I can do it! Sigh. It is a long process and a long recovery.
I know many people have one done at a time. Fortunately for me, I did not have a good leg to stand on and had them both done at the same time. For me, it was the very best decision! I had one surgery, one recovery, and have had to work evenly on both legs. I was 58 years old at the time, had been a Physical Education teacher in my past, and am self employed as a Family Child Care Provider caring for up to 6 preschool children daily. I have remained active over the years until I could no longer go for a walk at the end of the day because my knees hurt so badly. I could not hike, ski, and my quality of life was impacted greatly. I wanted the surgery to be done so I could get my life back. I see that happening now.
Please be patient with yourself. Continue to take your medication before PT, and pace yourself and your progress.
Best,
Crystal

 

[Jamie]

Kevin, I don't think you're an exception at all! Thirteen weeks is not very far along in the recovery process and I expect that things will feel better as you continue to work the knee and regain your muscle strength. It does take quite a lot of time for some people, not so long for others. But I think the majority take a while, so in my opinion you are very normal! Hang in there and keep up the good work!!!

 

[Josephine]

It's more likely an ilio-tibial band inflammation than anything to do with the implants. Unlikely you would be aware of the presence of the implants as you don't have any sensory (i.e. feeling) nerves in that area. You can see the ITB indicate on this image. The sartoious is another ligament that can get inflamed and spasmed. If the two go together, you can see how it would feel like 'leather straps' (good description, that!) around the front of your knee. It's a fairly common occurance and has been the topic of discussion in various threads, some giving stretching exercises to help. Doug is our expert on those but he's out of town just now.

 

[tinypoms]

I am 4 months out from a TKR on my right knee and 2 months out on my left. That strap feeling is exactly how mine feels. I tell people it feels like someone put a leather belt on my knee and pulled tight. It is getting less in my right knee but still bothers me in my left, a lot.

Joanie

 

[Josephine]

It's a very persistent condition.