TKR I just want to ride my bike. :(

[Mustang Shazzy]

Hello, thanks for this forum!

I am 6 weeks post right TKR. Hoping to have the left one done before the end of the year.

I discovered at 5 weeks by looking at the xray that there are at least 4 good sized pin holes in my femur and several in my tibia. Even though I was given quite a lot of things to read about the op, at no point was I told that it would be computer aided with markers fixed by pins to my bones during surgery. Don't get me wrong, this is pretty cool, I'm grateful for amazingly precise surgery that was 100% covered by medicare. But I would have liked to know.

The mid thigh and shin sites have been really painful, I was in quite a lot of pain initially and the nurses told me it must have been from a tourniquet during surgery. I thought the wounds were drain sites!

My thigh is still quite sore. Anyone else have similar pain at the pin site at this point?

Were you told you had holes in your bones?

Thanks

 

[Jockette]

Hi and Welcome!

Please tell us your surgery date and we’ll make a signature for you.

I did not have robotic surgery so I can’t answer the question about pin holes. I’m sure others will be along to let you know of their experience.

I did have the thigh pain from the tournique, but it wasn’t bad and only lasted a day or 2.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[Mustang Shazzy]

Thank you so much!

20th of May

I love this forum! So glad I found it. I was told that the ROM I could achieve at 6 weeks would be it, pretty happy to see that's not true. Only at 110 or 115 on a good day, my leg hasn't been straight for about 3 years, so I still have 5 degrees to go while I combat the tightness with rice bags on my stretching.

Now I know I still have time to improve, it's a great load off my mind.

Thanks for your time working here.

 

[Jockette]

I was told that the ROM I could achieve at 6 weeks would be it,

I seriously don’t understand where they get this from, we have countless members here who gained ROM for quite a while. Mine continued to improve well into my second year, and I even felt I had a bit more in my third year!

110-115 at less than 2 months is great. Many take longer to even get that. 5 degrees from straight is practically there, so no worries!

 

[Cjackso21]

Hello, the last TKR revision I had (have had many revisions) used robotics. I too was surprised to see the holes, mine were larger than pins though, maybe screw head size. These did hurt and I was surprised by them too. But that went away fairly quickly, in maybe a month or 2. But the TKR was amazingly better than the others I have had. I got full range of motion in about a month. Since I had one other TKR revision that was very difficult, I have something to compare it to. I also had a great surgeon. The small amount of pain from the holes was way worth it! Good luck!

 

[FLX4]

I had robotic PKR. The surgeon did tell me that they would be putting guides in the shin and thigh - I agree it would have been nice if they had walked you through all of it before surgery. Both sites hurt initially. I am 25 days PO and the shin still hurts some but is getting better.

 

[ski_bum]

What I have is IT Band issues that start in my hip, to my knees, and Shins. Both legs.
Good luck with recovery.
If I had a choice now I would have done both knees same time so it is only one year recovery.

 

[Susie-Q]

I had the robotic surgery this last time too. I had the spot on my shin where they put a guide in my tibia but didn't have anything on my thigh. I did have the thigh pain from the tourniquet in the first few weeks. I was surprised at how tender the spot on my shin was for many months but it's definitely gone now. Bones take a long time to heal.

It sounds like you are doing great! Happy recovery!

 

[Mustang Shazzy]

Hi, sorry, big sook ahead.

9 weeks post surgery. At 5 weeks I had achieved 110 degrees but as soon as I hit 6 weeks and started driving, shopping and walking without a cane I feel like I am on a see saw of overdoing it then resting and both make me stiff. I have not found a sweet spot of activity and have not managed more than 105 degrees since 6 weeks. Was progressing well until then. The thing about 105 degrees is that it doesn't get me over the top of the revolution on my stationary bike. Seat on 10 (usually 7), dragging with the stirrup because it's too high, some days I can just manage it and get up to 60 rpms for 10 minutes but most days I can't do even one revolution.

After 105 degrees I have sharp pain in the medial side of my knee and it may as well be made of stone. If I walk too much my hammies, quads and calf scream at me - especially my quads where they drilled into my femur. At night my femur and tibia ache and I can't get by without panadeine forte. I had a bleed into my calf during surgery and it's still a hard lump in there.

GP won't give me any more endone, so all I have through the day is panadol and that's useless. Physio has said I have to spend 30 minutes a day bending to the pain point. It doesn't get better though.

I think I am just having a big vent here. No post op blues so far but these days I am starting to have a cry because I can't ride my bike and I am afraid that I never will be able to, that I'm always going to be stuck with this pain when I thought I did the op so it could go away.

The cherry on top of my sook is that the bone on bone OA was in both knees and my other knee has been doing extra work and is really extra painful. I was going to get it done this year, but for the first time I am wondering if it is worth having two knees that won't bend past 105 degrees, won't get me on my bike and won't allow me to walk pain free.

The cream on top of the cherry on top of my sook is that I normally exercise every day. I haven't really exercised since before the op. I am comfort eating because I am in pain and I am putting on weight. And the more weight, the more pain.

Sorry for the big sook.


Does it get better? I really just want to ride my bike.

Thanks for listening to my sook.

 

[Jockette]

Does it get better? I really just want to ride my bike.

Yes, it does get better, and you will ride your bike.

But, you have to heal first.

Right now you have to change what you’re doing, and change your expectations.

You are doing far too much activity which is keeping your knee inflamed and swollen. Cut way back on all you are doing and spend more time resting, icing and elevating. Don’t look at this as ”doing nothing” look at is as giving your knee the best opportunity in which to heal.

This is a year long recovery, so 9 weeks is still early days.

Physio has said I have to spend 30 minutes a day bending to the pain point.

This is another reason for your pain, swelling and reduced ROM. If you are trying to do this, please stop. Forcing your knee to bend more than the swelling allows does not help, but hinders recovery.

Try to relax, stop doing things that hurt, and give your knee the privilege of sorting itself out. It will, if you go gently.

By the way, I merged your newest thread with your original recovery thread, as we prefer that members in recovery have only one thread.

This benefits you because all your information is in one place, easy to find, and maintains a nice journal for you.

This also benefits our staff, as your information is all in one place, and we often go back through your thread for previous details, so we know what you‘ve been through which helps us advise you better.

So, please keep all your posts in this thread. If you’d like a new title, let us know what you want, and we’ll change it for you.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?

Best wishes on your continuing recovery!

 

[sistersinhim]

I was told that the ROM I could achieve at 6 weeks would be it, pretty happy to see that's not true.

Oh, this is so wrong. At 6 weeks the knee is still really swollen. A swollen knee isn't able to bend well. Get that fluid out of your knee and your bend will improve.

Physio has said I have to spend 30 minutes a day bending to the pain point.

This is keeping your knee swollen and keeping your knee from bending as well as it will when the swelling is down. Think of filling up a water hose with water and the nozzle closed off. Try to bend it and fold it up. You can't. But, open up the nozzle and drink out that water, and the hose will fold right up. Your knee is the same way. Get out the fluid, lowering the swelling and the bend gets better. Painful exercises are keeping your knee inflamed which keeps it swollen. Cut way back on your activities for the next month and you'll get good improvement. There are quite a few of us that never did exercises or took PT and have done great in our recoveries. That's proof that exercise doesn't make the knee bend better, time and gentle movements do.

 

[CamGram]

Hang in there @Mustang Shazzy, it will get better! I agree with Jockette and sistersinhim that you’re overdoing it and that your knee is telling you to slow down.

Like you, I had bone-on-bone pain in both knees and really struggled with pain after my first TKR. My “new” knee was stiff and tight while my “old“ knee was still incredibly painful. Some days I wondered if I had simply traded one pain for another but I told myself that the TKR pain would eventually get better while the arthritis pain would only get worse.

I had my second TKR five months after my first (I waited longer than I would have liked due to scheduling delays, holiday plans and Covid). Even though I once again had post-surgical pain, my arthritis pain was immediately gone and that was wonderful. I suspect you will have the same experience when you have your second surgery.

I used to spend 5-6 days a week at the gym. That came to a screeching halt shortly before my first TKR and, like you, I did a lot of comfort eating and gained more weight than I was comfortable with. You are probably also missing those exercise endorphins. Don’t worry, the weight will drop off and those lovely endorphins will return when you get back to your old routine. And you will be able to enjoy your workouts even more without that horrendous bone-on-bone pain! When my OS eventually cleared me to return to the gym, I greatly reduced both the weight I lift and the number of reps I do. I also began walking in the pool and really love the way that feels. And I am now riding a bike with almost no pain for the first time in years!

Everyone here will tell you that it will probably take you a year or so to recover from this surgery. Recovery is slow but it does eventually come. I don’t feel fully recovered yet but I can do almost everything I want to do. I also know that I will continue to improve because I see a tremendous difference between my five month old knee and my ten month old one. (And the ten month old feels pretty darn good!)

Are you icing and elevating regularly? Initially, I iced and elevated during the day and also when I went to bed and felt that helped me even more than drugs. Even now I regularly ice and elevate my left knee during the day.

Are you getting enough sleep? Everything is more difficult when you’re sleep-deprived. And don’t push yourself (or allow anyone else to push you) to the point of pain. Your knee will let you know what it can handle; as people on this site will tell you - the knee is in charge! You will get past 105 and ride your bike and walk without pain. It just takes time and patience (so easy to say, so difficult to accept). You can do this!

 

[Roy Gardiner]

my leg hasn't been straight for about 3 years

Your body will have adapted to this. It will take gentle stretching, every day (or more than once a day) to regain full ROM. But it's perfectly possible.

I really just want to ride my bike

You will.

See My ROM, Extension and Quad exercises. and a static bike for ROM and my BILATERAL TKR Recovery Diary

Static bike:

• Set the bike to zero resistance
• Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm. If you can't make a rotation, lift the saddle as high as possible, and pedal with tippy-toes. Try also pedalling backwards.
• Gently turn the pedals, through discomfort but without pain.
• Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
• Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
• Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
• And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't

Here is a bit more chat and some pix and how 'healing' and 'training' are different

 

[Mustang Shazzy]

Thanks everyone. I needed to hear all of this. Appreciate your time

 

[Samsrf]

Hi there @Mustang Shazzy - It’s all good!!! You are doing great. I have had my ups and downs as well and had a very
hard time going back to “normal life” at 6 weeks (you can read my thread) I will pass on what my general doctor told me “Give yourself some Grace!” It gets easier. I am at 17 weeks ish - and I have sort of stopped counting. I go through my day and think - “my knee hurts” and Then I look back- no Tylenol for days, no other meds & I haven’t iced in 10 hours! Then I think “wow I had a normal day and I am only 4 months out “ That’s pretty darn good!!! I put some ice on make a cup of tea, give myself some Grace- everything else can wait for tomorrow and rest. Hang in there!

 

[Newbee]

Hello Mustang Shazzy!I had left tka August 30 2021.Right tka Nov 23 2021.I was very bow legged prior to surgery.Not sure what my problem with flexion is???I had great flexion prior to surgery.I now have mid 90s.I just want to ride my bike :( I go for second opinion in two days.My doc thinks it is arthrofibrosis,wants to scope???I am not good with doing that yet.But I want to ride my bike!Let me know how you are doing.Best wishes!

 

[Mustang Shazzy]

Hello Mustang Shazzy!I had left tka August 30 2021.Right tka Nov 23 2021.I was very bow legged prior to surgery.Not sure what my problem with flexion is???I had great flexion prior to surgery.I now have mid 90s.I just want to ride my bike :( I go for second opinion in two days.My doc thinks it is arthrofibrosis,wants to scope???I am not good with doing that yet.But I want to ride my bike!Let me know how you are doing.Best wishes!

Hello Newbee,

I can relate to all of that. The OA had killed the medial sides of my knees and both had caved in so I was bow legged too. Initially my hurdle was getting my knee straight because it wasn't strait for years and I did really well with flexion until I hit a brick wall.

I know everyone here is telling me to be patient, it will improve, it's a long recovery and believe all that. But at the same time the window for attempting rectification with MUA is not that long, my weight is ballooning and I never once considered that I wouldn't be able to ride post surgery.

My surgeon says that all his patients are happy with 105 degrees because they are generally older and all they want to do is be able to walk, and obviously I can do that. He described cycling and leg day at the gym as "sports hobbies" as though they were not that important. I begged to differ.

So I am down for the second knee, hospital is not doing elective surgery because of COVID spike, but maybe before the end of the year. And if with all the exercise physio and recliner bike riding I still haven't pushed past 105 and got back on my upright then he will do a MUA on the first leg at the same time to break up the scar tissue.

So let me know how your second opinion goes.

My exercise physio has given me a program. Not sure if I am seeing any progression yet but I can ride 5km on the recliner bike now. Increasing by 1 km each day.

Good Luck

And thanks everyone else for your encouragement and shared experiences! I'm not really sure how to reply to you.

 

[Jaycey]

But at the same time the window for attempting rectification with MUA is not that long

There is no window of opportunity post TKR. This is very old school thinking. Your ROM will continue to improve for quite sometime. Many of our members report improvement in the second year following their surgery.

You might want to read this article again Myth busting: the "window of opportunity" in TKR.

 

[Roy Gardiner]

I can ride 5km on the recliner bike now. Increasing by 1 km each day.

If you want to train, that's fine, although ramping up 1km each day seems too much to me. If you want to help ROM it's not the best, IMO.

Using a bike to gain ROM is pretty simple:

• Set the bike to zero resistance
• Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
• Gently turn the pedals, through discomfort but without pain.
• Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
• Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
• Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
• And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't

Here is a bit more chat and some pix and how 'healing' and 'training' are different

 

[Mustang Shazzy]

But at the same time the window for attempting rectification with MUA is not that long

There is no window of opportunity post TKR. This is very old school thinking. Your ROM will continue to improve for quite sometime. Many of our members report improvement in the second year following their surgery.

You might want to read this article again Myth busting: the "window of opportunity" in TKR.

Yeh, no, not the ROM, I'm talking about the MUA. The studies show that they are most effective when done within the first 8 weeks. https://bonesmart.org/forum/threads/mua-manipulation-under-anaesthetic-and-adhesions.3656/