Bilateral TKR Hyperextension post BTKR

JBH

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I’m six months post-bilateral TKR with ROM 126/0 in both knees after 50 intense sessions of physical therapy. Prosthetic placement is perfect. However, I’m 3-5 degrees hyperextended in my left knee at the standing phase of my gait. I have pain, stiffness and instability in my left knee. I also have left foot supination, left hip pain while walking and have calcium fragments in my left quad near the kneecap. I used the best knee surgeon in town who said he’s never had a patient complain of post-op hyperextension and that I’m “hyper-sensitive” and “hyper-aware.” Are there any exercises that can fix this. My surgeon has suggested that a slight heel lift in my shoe may help but is already considering surgical repair next year.
 

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Tykey

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Hi, JBH, and welcome.
One thing seems to stand out in your post.
I would suspect your 50 intense sessions of PT have stretched your ligaments when you are wanting them to tighten up and make your knee stable.
It wasn't necessary, most of us on here recover well with minimal or No physiotherapy. Knees just get better if you treat them kindly
I'd suggest you just stop trying to abuse your knee into submission, just get on with the normal things in life and let it recover.
PT hasn't done it for you!
Good luck.

PS autocomplete on your computer decided that you have high blood pressure in the title. I was confused when I first read it
 

Celle

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Hello @JBH - and :welome:

Please will you tell us the full date of your knee replacements, so we can make a signature for you? Knowing the exact date will help us to advise you appropriately in the future.
Thank you.:flwrysmile:

Did you mean "hypertension" (which is high blood pressure) in your thread title, or did you mean "hyperextension"?


if you meant hyperextension, which I think you did, we can change the title for you.

If you are still doing physical therapy (PT), I think you should stop. Your knees don't need it any more and those intense sessions might have had something to do with the hyperextensoin you have now.

Treat your knees gently and just use them normally, in your everyday life.
All that intense PT didn't give your knees a chance to settle down and heal from the trauma of surgery.

Although it's been 6 months since your surgery, I'm going to give you a copy of our recovery guidelines, because they contain a lot of sensible advice:

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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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. Try to 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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 
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JBH

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Hi and thank you. The date of my surgery was 12/13/19. I meant at all times “hyperextension” not “hypertension.” (Darn auto-correct.) Not sure the intensity of PT or lack thereof caused the looseness in my knee. From what I can tell, hyperextension seems to be an underreported result or side-effect of TKR. I guess most people just live with it. I can’t because it throws me off balance and interferes with my quality of life.
 
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JBH

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PS my thread title from my end reads “Hyperextension.” Please correct if possible.
 

Celle

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PS my thread title from my end reads “Hyperextension.” Please correct if possible.
Your thread title was amended, to say "Hyperextension."

The .pdf document you attached was interesting. I'm sorry, but I have had to delete it because we don't allow material from outside BoneSmart, unless a link to its source is given.

Please feel free to post a link to the document, so we can check its source and we can all read it without having to download it
 

Celle

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Thank you for you surgery date. I've done your signature and added your name to the December Supernovas surgery team thread.
The team thread is primarily to allow you to see who has had surgery the same month as you. Discussion of issues, comments, and questions regarding recovery must be kept in your individual recovery thread.
 
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JBH

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Got it. Thx
 

Jamie

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Sorry to hear of your difficulty with your new knees. Has your surgeon mentioned the idea of replacing your spacer to try and correct the hyper-extension? Is that the "surgery" he's talking about as a possibility in the future? Sometimes this can make a difference.
 
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JBH

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Yes, he mentioned that to me for the first time on Friday. But I have no idea what that procedure would require, or even what he means by a “spacer.” Whatever it means he was clear that it would require that he “open me up” again and I’m not looking forward to that at all. I feel like his practice should have to pay for all the expenses associated with an operation to fix the first once, since my insurance is not that great, and I’m sure rehab would have to start back at step one. In any event, I’m hoping that there is an exercise regimen that would correct the problem without addition surgery.
 

Celle

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Yes, he mentioned that to me for the first time on Friday. But I have no idea what that procedure would require, or even what he means by a “spacer.”
A spacer is the plastic part that's inserted between the metal components of knee replacement hardware. It's there to stop the metal parts from wearing on each other.
1588013327065.png

Spacers come in various thicknesses and replacing the one you now have with a thicker one would separate the metal components further, which could well compensate for over-stretched ligaments supporting the knee joint.

To replace a spacer would mean opening up your knee again, but that's a less serious operation than the initial knee replacement and, while you would be back to resting, icing and elevating for a while, recovery is faster than from the initial surgery.

If your surgeon decided to balance your external knee ligaments at the same time as replacing the spacer, that would be a more involved surgery and recovery would be longer.
 
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JBH

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Thank you. You really know your stuff. And a picture is worth a 1000 words. Now I can consult with my surgeon in a more informed manner. I should also mention that all elective surgeries at the hospital where my surgeon practices have been cancelled. So it will be awhile before he can do anything surgically to fix my knee. In the mean time he prescribed a slight heel lift which arrived today and which I have inserted it in my shoe. Not sure I have noticed a difference but I’ll give it some time.
 

bland9

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I have the same problem with my leg it will not straighten at all -MUA and two lots of physio could not resolve the situation and now waiting to see the surgeon again in September and still using two crutches to walk -physio gave me insole wedges to help with my leg which helps- though I have got pain with mine especially the medial side
 
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JBH

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Uggg! The thought of revisionist surgery makes me sick. Hope yours turns out ok.
 

Annie N

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May I enquire what has happened? Did you go ahead?
It turns out that I also have significant hyperextension and have had a replacement spacer suggested.
Did it happen - did it work?
I could do without the instability and 'collapse backwards' issues that are happening.
 

mtnplayva

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I'm also having this happen and the dr suggested a thicker spacer but he wants to wait until a year after surgery.
 

InkedMarie

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May I enquire what has happened? Did you go ahead?
It turns out that I also have significant hyperextension and have had a replacement spacer suggested.
Did it happen - did it work?
I could do without the instability and 'collapse backwards' issues that are happening.
The OP hasn’t been here since April 28, 2020 and will not likely see your post.

Marie
 

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