TKR Is ROM just a number?

[Mimi]

I have read many stories here about ROM. Some emphasize that their doctors want a good ROM early in recovery. Others talk about how ROM came slowly and they had to work hard to get it to where they wanted it.

My experience is a little of both. I started out with a ROM of 96 flexion and 18 extension when I got home from the hospital. The at home PT was interested in getting my ROM going. I had an infection and more swelling in the knee and leg that was necessary. My ROM increased very slowly with the extension being a problem. I was in a dynasplint for a month and it did nothing but cause me a good amount of pain and the inability to rest. :cry4:

My ROM at 5 months was 110 and 6. That is when my PT ended and my swelling started to finally go away. :yes 4: Within the month I could walk very well and my pain was almost gone. My Dr. did not measure me after that time and was very happy with my progress, even as slow as it was.

Well, today I visited my PT buddies and they measured my ROM for the first time in 9 months. Everyone was amazed at how well I walk . The last time they saw me they were not sure I would ever walk in as I did today! :skeptical: Much to their surprise and mine, my ROM was 115 and 0. My first thought was a bit of disappointment, then I thought, this is truly just a number. I can do everything including steps and do them well. I walk great, I can run, dance skip, just about everything I am happy with it all!

I am also glad that my PT and Dr. did not put the added pressure of pushing my ROM. I believe that it all comes together at each knees own pace. Mine was slow, but it is well functioning. My ROM pre surgery was 145 and 0 . But that knee did not function at all. :hissyfit: I limped, could not climb stairs, or dance , or run. Bending my knee was much too painful. So those great pre surgery numbers did me no good at all. :rolleyespink:

What experiences have you had with ROM?

 

[1ELISEA]

Good question. If you read my last entry (June 15th) on my progress under "ACK OMG TKR on May 29th" you'll see my experiences on ROM.

 

[referee54]

Well, today I visited my PT buddies and they measured my ROM for the first time in 9 months. Everyone was amazed at how well I walk . The last time they saw me they were not sure I would ever walk in as I did today! :skeptical: Much to their surprise and mine, my ROM was 115 and 0. My first thought was a bit of disappointment, then I thought, this is truly just a number. I can do everything including steps and do them well. I walk great, I can run, dance skip, just about everything I am happy with it all!

A VERY GREAT POINT!!!

To many people, ROM is all about the quantitative aspect--#'s, progress, etc. The PT's seem to obsess over it. Your point though, is excellent---it is all about the qualitative aspect of life. Can you do what you want to do? Are you happy with your new life? If you are happy, then ignore the numbers and get on living your life!

Let others worry about your ROM---that is what they get paid to do. You should not worry at all---as long as you are enjoying your life and what you are capable of doing, numbers mean nothing!

 

[Campervan]

Qualitative is what counts. Quality of life. If 110 gives you a functioning knee, doing what you need to do then why go through more pain just to improve a number. Yes, I'll need a bigger number before I can ski again but right now I'm happy walking.

 

[jerseychick]

Super thread Mimi! I think you are absolutely right, the number is just a number. What matters is what you CAN do with your new knee.

I struggled with ROM and sometimes think I should go back to the doctor to see what he says. My ROM at best is 105-110 degrees. I have absolutely no pain and there is not one thing that I can't do except for sit back on my heels, but I haven't done that since I was 17 yrs old. I can go for hours working outside and doing household chores. I take spin class around 4 times a week.
I'm not sure what I would do with extra ROM, but sometimes I get frustrated because lots of members have such high ROM.

I am pretty much happy with my ROM now, it's so much better than the 30 degrees I had before the surgery. I also have a pain-free and stable knee, something that I haven't had for years.

 

[Janet2012]

You only need what you need, right?

 

[jerseychick]

Exactly Janet!

 

[AussieBill1962]

ROM is just a number. I think if were able to get back to the physical things we love doing then that is a goal to be cherished. I measured my ROM this morning with my IPad to see my new right knee is at 121 and my left knee which works well is only 119. I know my left knee and leg are much stronger than my right and peddling my bike is harder with my new right knee. ROM is just part of the equation. Having a pain free strong joint is my goal.

 

[kneesrus]

Great post Mimi. I am going to print this one and hand it to my patients. It is amazing if you just let the tissues recover and don't be too aggressive, the motion returns. I currently am treating a MD who is hammering his knee to achieve more flexion. I keep telling him he is doing more harm than good. I showed him the motion in my last knee, and I was even shocked, on the amount of motion I obtained. I told him that I never forced the joint. Hopefully, your post will help.
Thanks,
David

 

[hapiheylo]

Did we go to the same pt people?? :confused: Your story is so similar to mine. My PT is finished also, except they want to use one of those dynasplints. I would like to work on my normal life, and get my knee stronger instead of those ROM #'s. Thanks for sharing.

 

[Larosser]

I totally agree with your point about the quality of your knee function! Who cares if you have insane ROM numbers if you can't function? I think that improvement in measurements can be important in situations when you can't really measure qualitative improvement yet - like soon after surgery when you're doing PT at home and can't really do much. It that situation, I found that increasing my flexion or extension by a degree or two gave me something to work for.

But once you get back on your feet, the real measure of success is whether you can do what you want to do, for as long as you want to, without pain.

Best
La

 

[Dhare63]

Hi Mimi,

You are spot on, it is about the quality of life you attain. The numbers don't tell the story of whether you are able to do the things that are important to you, whatever that may be. The definition of success will vary all over the place, and each person must define success for themselves.

Congrats on your journey and your infectious positive attitude. You are an inspriration!

Be well my friend,

Dawn

 

[referee54]

Unfortunately, many of us tend to forget what we couldn't do before our TKR or our BTKR. After our successful recovery, we are back to doing what we loved to do so much---prior to arthritis stealing our activity from us. Then , we concentrate only on numbers and do not realize that we are doing things that we have loved to do so much---and are possibly enjoying doing them more. We focus too much on the numbers and not enough on our enjoyment of our life!

 

[skigirl]

I thought I would give you some interesting numbers which I read in an article written by Dr. Noyes who works in the Steadman Clinic in Vail.

Normal ROM is usually minus 5 to 143 degrees in women.
norrmal rom is usually minus 6 to 140 degrees in men.


You use your knee in normal walking is 70 derees of flexion. That is the range you need to wlk, to go up and down stairs and to have a normal gait.

93 degrees is required to rise from a seated position.
106 degrees is needed to tie your shoes!
135 degrees is needed to get in and out of he bathtub for a bath.

I do know that if the leg cannot full extend--an extension of 0, then the quads do not engage properly. In the tka leg, the quads are often unresponsive after surgery and we have to "wake them up" with e stym and lots of quad sets. Howeve, if you cannot straighten the leg completely, the quad does not engage properly which puts a strain on your ligaments and muscles.

I really agree that it is important to gain the rom that you need and not worry about too much. I easily got to to a rom of 145, but I felt that I had to get to 150--just because I wanted to get everything from the knee. I sat on my heels, did lots of yoga, etc.

then my doc told me that my knee did not want to bend tha much and that it was slightly twisting when I bent it that much which caused my ligaments to stretch a little. He has hammered into my head that I am not to go over 145 with my knees.

Even though I have good rom, I still feel hampered by my knees---to look under the bed, I put my hands on the floor and then come down into the push up position. I lower my self to the floor and look under the bed. Then, I go back to the push up position and "walk" my feet forward to my hands and then stand. I still remember when I used to knee down, sit on my heels and then bend forward to look under the bed!!!

When I am lying on a mat on the floor---I used to have to roll over and come up to hands on the floor and feet on the floor and then walk them in and stand up. Now, finally I kneel on one knee and then push up to standing. But it would be worse without the rom that i have. I have to hop into ski boots every day, bend down to help people with their boots and check their bindings.

Also, I have to ski which requires a rom of 130. So, just to do my job, My rom has to be at least 130. I am eight weeks out from surgery right now and both knees are at 140---that was the other thing that the doc told me---try to keep them the same. If I really stretch the right, it easily move to a 145--but, I am not working on it until the left is also 145. Hopefully, I can still kneel down in the snow to check people's bindings and boots. And. put on my own boots without wrecking my back!!

 

[Jamie]

Kelly....maybe you should stop looking under the bed! Nothing there but dust bunnies anyway......

Sorry....I just couldn't resist.....

 

[PooShay]

I thought I would give you some interesting numbers which I read in an article written by Dr. Noyes who works in the Steadman Clinic in Vail.

Normal ROM is usually minus 5 to 143 degrees in women.
norrmal rom is usually minus 6 to 140 degrees in men.


You use your knee in normal walking is 70 derees of flexion. That is the range you need to wlk, to go up and down stairs and to have a normal gait.

93 degrees is required to rise from a seated position.
106 degrees is needed to tie your shoes!
135 degrees is needed to get in and out of he bathtub for a bath.

I do know that if the leg cannot full extend--an extension of 0, then the quads do not engage properly. In the tka leg, the quads are often unresponsive after surgery and we have to "wake them up" with e stym and lots of quad sets. Howeve, if you cannot straighten the leg completely, the quad does not engage properly which puts a strain on your ligaments and muscles.

I really agree that it is important to gain the rom that you need and not worry about too much. I easily got to to a rom of 145, but I felt that I had to get to 150--just because I wanted to get everything from the knee. I sat on my heels, did lots of yoga, etc.

then my doc told me that my knee did not want to bend tha much and that it was slightly twisting when I bent it that much which caused my ligaments to stretch a little. He has hammered into my head that I am not to go over 145 with my knees.

Even though I have good rom, I still feel hampered by my knees---to look under the bed, I put my hands on the floor and then come down into the push up position. I lower my self to the floor and look under the bed. Then, I go back to the push up position and "walk" my feet forward to my hands and then stand. I still remember when I used to knee down, sit on my heels and then bend forward to look under the bed!!!

When I am lying on a mat on the floor---I used to have to roll over and come up to hands on the floor and feet on the floor and then walk them in and stand up. Now, finally I kneel on one knee and then push up to standing. But it would be worse without the rom that i have. I have to hop into ski boots every day, bend down to help people with their boots and check their bindings.

Also, I have to ski which requires a rom of 130. So, just to do my job, My rom has to be at least 130. I am eight weeks out from surgery right now and both knees are at 140---that was the other thing that the doc told me---try to keep them the same. If I really stretch the right, it easily move to a 145--but, I am not working on it until the left is also 145. Hopefully, I can still kneel down in the snow to check people's bindings and boots. And. put on my own boots without wrecking my back!!

Totally agree with this post. The number in itself may not be important to you, but it is important to your knee since it will not be able to do certain things.

My doc also mentioned that eventually the two knees will be very close in ROM (I'm a bilateral). And MOST people get to 135 in about a year. So it pays to continue the stretching exercises. The more you can bend your knee, the more you can do IF YOU ARE SO INCLINED. If not, well, be happy with what you have.

 

[Mimi]

Good posts Kelly and Poo Shay. I agree with them both. However, I have continued my exercises, ride a stationary bike at least 1/2 hour a day , and do water exercises 2 times a week. My ROM is 115, and I can get in and out of a tub (since last fall), look under the bed and kneel with no problem. So it may be that just as all recoveries are so different, so are the knees themselves. I am not just happy with the knee as is, but because I have a well functioning knee with my TKR.

Also, I have only one TKR and my other knee ( that will need a TKR some day) still has a ROM of 145. How to get them both the same, would be amazing, but not too possible, in my estimation. My 145 does not function as well as my 115 TKR. We are just all so very different, and need to find what works for us.

 

[GrandyGirl]

I find it interesting information to see how the ROM numbers correlate with certain activities. Personally, I don't focus too much on the numbers. I know that if there is something I want to do and am having difficulty doing it, I probably need to either continue to heal or stretch the ligaments and muscles around the knee. Something had made a huge, quick difference in my ROM was holding the stretch rather than just going thru the motions. I saw results within a few days. Also after a few weeks, I began using heat to loosen the tissue and found that I was able to move my knee much more than without the heat. The results were increased ROM which remained even after I stopped applying heat. Still, I think the most important factor is TIME and working consistently to regain flexibility and to become thoroughly acquainted with this new knee device.

Dori
aka GrandyGirl

 

[skigirl]

I agree Dori. I work out in a warm or therapy pool every morning and that is where I do my stretches. One thing that sometimes prevents stretching is a shortened quad muscle. So, I work on thinking about lengthening my muscles and then stretching. I also hold the stretch for a minute or so. The warm water helps me to stretch the knee. I often go to the pool on the way home from skiing--after a day spent in a mostly bent knee position, I need the stretching the pool provides.

 

[jerseychick]

I thought I would give you some interesting numbers which I read in an article written by Dr. Noyes who works in the Steadman Clinic in Vail.

Normal ROM is usually minus 5 to 143 degrees in women.
norrmal rom is usually minus 6 to 140 degrees in men.


You use your knee in normal walking is 70 derees of flexion. That is the range you need to wlk, to go up and down stairs and to have a normal gait.

93 degrees is required to rise from a seated position.
106 degrees is needed to tie your shoes!
135 degrees is needed to get in and out of he bathtub for a bath.

I do know that if the leg cannot full extend--an extension of 0, then the quads do not engage properly. In the tka leg, the quads are often unresponsive after surgery and we have to "wake them up" with e stym and lots of quad sets. Howeve, if you cannot straighten the leg completely, the quad does not engage properly which puts a strain on your ligaments and muscles.

I really agree that it is important to gain the rom that you need and not worry about too much. I easily got to to a rom of 145, but I felt that I had to get to 150--just because I wanted to get everything from the knee. I sat on my heels, did lots of yoga, etc.

then my doc told me that my knee did not want to bend tha much and that it was slightly twisting when I bent it that much which caused my ligaments to stretch a little. He has hammered into my head that I am not to go over 145 with my knees.

Even though I have good rom, I still feel hampered by my knees---to look under the bed, I put my hands on the floor and then come down into the push up position. I lower my self to the floor and look under the bed. Then, I go back to the push up position and "walk" my feet forward to my hands and then stand. I still remember when I used to knee down, sit on my heels and then bend forward to look under the bed!!!

When I am lying on a mat on the floor---I used to have to roll over and come up to hands on the floor and feet on the floor and then walk them in and stand up. Now, finally I kneel on one knee and then push up to standing. But it would be worse without the rom that i have. I have to hop into ski boots every day, bend down to help people with their boots and check their bindings.

Also, I have to ski which requires a rom of 130. So, just to do my job, My rom has to be at least 130. I am eight weeks out from surgery right now and both knees are at 140---that was the other thing that the doc told me---try to keep them the same. If I really stretch the right, it easily move to a 145--but, I am not working on it until the left is also 145. Hopefully, I can still kneel down in the snow to check people's bindings and boots. And. put on my own boots without wrecking my back!!

I think that your flexibility, body composition, and strength can determine whether you can accomplish certain tasks, not necessarily the ROM number. My ROM is between 105-110 and yet I can get up and down off the floor, spin, get in and out of a tub, gallop down the stairs, etc. I am petite, flexible, muscular and strong. I am sure that good physical condition works to my advantage despite my limited ROM.

Before my TKR I was able to tie my shoes with a limited ROM of around 30 degrees! I was also able to rise from a seated position with my limited ROM. I say forget the number, it's function that counts!