TKR Incision site

[Celle]

. It takes a lot 30 minutes of stretching and massage to get it to about 80’ I’m at 5 weeks today. I’m wondering if anyone else experienced this, or when people talk about stiffness if this is what they are referring to?

That sounds like the normal, early-morning stiffness after a night of relative inactivity in bed. I don't think you have to work so hard to get it to go away. Stop worrying so much about the ROM numbers. Just walk a bit. The stiffness will gradually go away.

I see my surgeon tomorrow. His nurse had told me he wants 115’ by 6 weeks or he does an MUA. That is NOT something I want to do, but I also don’t want to have to take so much time just to get moving every day. It is very tiring.

So stop spending all that time. It's not necessary. Let your knee do what it wants. It knows what it's doing - healing on its own schedule, not anyone else's. Where are you in recovery?? (TKR)


Your ROM is progressing and you don't need an MUA. The only reason to do one so soon is impatience.
All that having an MUA at this stage will do is re-injure some of the soft tissues that are just starting to heal.

Even if your surgeon isn't satisfied with your flexion, you can ask to be given more time, telling him that it is progressing steadily. You have choice, remember. You don't have to blindly follow orders or advice. It's your knee.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

 

[Jockette]

but I also don’t want to have to take so much time just to get moving every day. It is very tiring.

Much of this recovery is very tiring and a lot is out of our control. The knee is in charge, not you, your PT nor your surgeon.

5 weeks is extremely early in a 52 week recovery.

 

[MaryMC]

I’m not so sure it’s swelling- my knee is back to its normal size now. I even lost my cankles! I was diligent about ice and elevation and it only swells at all if I am up on it too much.

And .... I hit 90’ in PT today! Without tears or forcing, just some stretching and a gentle ease into it while I was on the bike!

I am hoping having more like 8 weeks would be reasonable before thinking about MUA. I would like to see what being in the pool would do, if the OS gives me the go ahead to swim. I think swimming and hot tub would be helpful- has anyone else had progress from the pool?

 

[DebCoz]

Mary, I’m at six weeks post-op and am at 90 and +3 (straightening). If my surgeon suggested MUA by week six I’d tell him no. I’m getting more bend every day with PT twice a week, sometimes once if I’m having soreness and swelling. The best thing was finding the advice on this forum.

 

[kneeper]

For many docs or PTs 90 degrees is the holy grail. Once I hit 90 my doc just said keep on doing what you're doing--use the knee as much as you tolerate. And I continued to progress.

 

[NavyGunns]

@MaryMC from what I’ve learned about your progress, I’m in agreement with all the others. You are making great progress! You should be concerned about having a MUA, but also remember, your OS can’t do anything without your approval! Regardless whether he says you need it, if you say no, not yet, he can’t do anything.

In an earlier post you asked where most people were experiencing pain or tightness on flex. For me (I had a lateral PKR left knee), my knee is tight right over the knee cap and along the medial side of my incision. In fact, the incision is to the medial side of my knee cap (which I don’t understand since it was the lateral compartment that was replaced). All I know is that I have a lot of soft tissue healing going on in those two areas that get swollen and tight when I’m active. That then makes bending the knee a bit more challenging.

Stiff knees in the morning or after sitting with your leg elevated for a while will be normal. Just get up and start moving. It will loosen up real fast.

Keep up the positive spirits and just keep plodding along. You will be fine.

NG

 

[MaryMC]

Something seems very wrong. It’s 1am. I had a massage tonight, she worked my leg but she also worked the rest of my body. Nothing felt too much of too hard or anything that made me want to stop her. Every since then I’ve been getting very local sharp zinging feelings in my knee. It’s near the proximal side of my kneecap, underneath it a bit. They came more often now, ever 30-60 seconds and feel like a sharp nerve type pain that lasts a few seconds. Ice seems to help it calm down a bit. But this is round three of icing in the last few hours because they came on so strong.

Anyone ever hear of such a thing. My spouse wanted to take me to the emergency room but I refused. I have a high pain tolerance, but this takes the wind out of me each time it zings me.

 

[Celle]

I hit 90’ in PT today! Without tears or forcing, just some stretching and a gentle ease into it while I was on the bike!

I am hoping having more like 8 weeks would be reasonable before thinking about MUA.

Congratulations on reaching 90 degrees. Now stop worrying. Let your PTs obsess about the ROM numbers. You don't have to, because function is more important than those numbers. What you want is a strong and reliable knee, and that is going to take time.

Very few surgeons even think about doing an MUA once you have reached 90 degrees.
What's the rush? ROM continues to improve for at least a year post-op. In spite of what you have probably been told, there isn't any deadline you have to meet.

For what it's worth, even if you don't see any external swelling on your knee, there will still be some internally, plus tissue damage. Your knee is still healing. You can't expect it to perform as well now as it will when it is fully healed.

 

[SusieShoes]

Zinging pains often are more memorable than they are meaningful. I hope other people come along to talk about their zingers. Most zingers amount to little more than reconnecting nerves.

Nerves that get cut during the surgery attempt to reconnect afterward. Some do so fairly early on; others might not get there until much later. Part of the way nerves do so is to send electrical signals -- signals you can feel. Those signals can be surprisingly powerful.

I was walking down the sidewalk one morning about four months after surgery and got walloped by a zinger in my left knee. Just shot through the knee without warning. Once. Twice. I kept walking but was nervous. What was it? Was something wrong with my knee? Another one. I slowed down. Kept walking and thought about going back home (I had only gone half a block). But then the zingers calmed down. And a bit later they stopped. They never came back.

So ice and elevate (it could be that swelling is irritating a nerve, you never know for sure) and see what happens. If the pains continue or get stronger, call your OS and explain what's going on. Some people do develop nerve pain that requires medication. Most of these zinger pains, though, go away on their own.

 

[MaryMC]

Thanks everyone. Thanks Susie- wow what a night! The zingers lasted for about 5 hours, like labor pains in my knee! I have tiny ones this morning but nothing like those. Scary! What a way to say it’s waking up!!

 

[sistersinhim]

I’m not so sure it’s swelling- my knee is back to its normal size now.

You will still have swelling inside that is causing that stiffness. Stiffness hangs around for a while. Continue to ice your knee along with elevating. That will help lessen the swelling inside your knee.

I had a massage tonight, she worked my leg

It sounds like your knee is not ready for this and woke you up with those pains. I'd not let them touch your knee anymore for a while.

 

[MaryMC]

Quick knee update. It’s week 5. Saw doc today. He feels like things are going well considering how challenging a surgery this was to perform. He is giving me 3 more weeks to get to 115-120’ of flexion. I’m at 90 today. If I’m not there in 3 weeks then he will do a manipulation under anesthesia. Doc hugged me and had tears in his eyes- he really gets how this will have changed my life.

 

[Celle]

He is giving me 3 more weeks to get to 115-120’ of flexion. I’m at 90 today. If I’m not there in 3 weeks then he will do a manipulation under anesthesia.

There really is no need to rush to get ROM. How many times have we told you that?

You don't have to comply with your surgeon's requirements for ROM. Your knee is on its own agenda for healing and it will do really well, as long as you don't allow it to be sabotaged by trying to make it adhere to an artificial timetable.
Where are you in recovery?? (TKR)

And, you don't have to have an MUA. It would be completely unnecessary surgery in your case.
He can't do anything without your consent.

Be patient. You can't make your knee heal any faster than it wants to, no matter what you do, but if you overwork it, you could retard its progress.
Your knee is in charge of its own recovery and it will recover at its own pace - not your surgeon's pace and not your pace.
TKRs and our fast food society

 

[MaryMC]

I was feeling pretty positive about the appointment. I’ve made great progress and he thinks I have to. Doc thinks I can get to 115 on my own without MUA. MUA after 8-12 weeks on had a risk of breaking the femur, so I can understand him having a time frame with a risk that big.
I work hard. It may not be necessary the way you all agree, but I also listen to my body. It feels right to me. When it hurts I stop. I ice. I nap. I elevate. But when it lets me, and it’s allowed me to do a lot, I move and walk and stretch. Until it tells me to slow down again. I take care of myself- I meditate, get massages, acupuncture, reiki. I think positive and ask my knee to give me more if it can, and if it can’t, then I listen.

I have a doctor that has known me for 15 years - through multiple injuries and setbacks and has waited patiently with me until now. I trust him - he put the knee in, then took it out and totally reconstructed my knee because my body would not accept the artificial joint with my anatomy. And it seems that he believes in me that I’ll get my ROM back as well.

I’m feeling hopeful and positive.

 

[kmak81230]

I think you will get to the doc's desired (and yours) ROM but it may not be on his timeframe of three weeks and 90 at 6 weeks is awesome. Some of us are slow to get the desired ROM, but we eventually get there. I don't think you will need an MUA - just more patience and time to heal. I barely hit 90 at 6 weeks and didn't get to 110 until 4 months and stayed there for another month. At one year out I am consistently at 125 and can do everything I want.

I also think the massage may have been too much for your knee at this early point in recovery. I had a massage several months in as I was struggling with extension and I thought it would help loosen up my super tight calves and hamstrings - it felt great at the time but oh boy was I sore later - took me several days to recover.

Hang in there and be good to your new knee.

 

[kneeper]

It really sounds like you're doing fine. For me the key was to listen to the knee and be very gradual in increasing activity or exercise. Kind of like do something and then see what the knee has to say about it. It sounds like you're trying to do that.
A note on "zingers"--they'd come on me like a firestorm and then go away as mysteriously as they came on. Until the next time. But they did go away.

 

[MaryMC]

Thanks for all the info on the zingers. Good to know they happen!

I eased right into 94 today.

 

[Marguette]

I saw my surgeon at 5 weeks and has 106'. He was happy with that and said it would continue to improve over time as I resumed daily activities. He encouraged me to continue with exercises for three months. My PT team said the would recommend six months. Both the surgeon and the PT team emphasized doing what I can but don't continue if it hurts or if it causes too much swelling. I'm pretty pleased with this approach. I'm now at week 8 and have little need for pain meds and my ROM is improving slowly.

This site has been really helpful in helping me reduce my level of anxiety around setting up high expectations and just accepting that it is ok to go at your own pace.

 

[MaryMC]

Thanks for that- I haven’t been taking anything more than ibuprofen once in a while. I don’t feel like I need the meds anymore, and I think the oxycodone was actually making me unable to sleep well.

Marquette can I ask what your ROM is now? Thanks for that, it’s always good to hear other’s experiences. I haven’t been taking anything more than ibuprofen once in a while. I don’t feel like I need the meds anymore, and I think the oxycodone was actually making me unable to sleep well.

It seems to go baby steps by baby steps.

 

[MaryMC]

Not sure what happened just then