TKR Jenn’s Recovery<

[Dolly Girl]

Jenn, I'm sorry I didn't see this question . My PT is very minimal. A few heel slides, a couple times a day, a few quad sets and walking around . My first TKR was 2 years ago and I had more aggressive PT and had a much harder time. My ROM is 0 and 110.

 

[donnag1108]

Hi @Jenn I am really feeling the blues today to almost to tears. I don't miss the arthritic pain but I miss my life. Working and being independent doing what I want and still in pain. This is so hard.

 

[sistersinhim]

I am really feeling the blues today to almost to tears.

These blues are so depressing. But, you are among company. Just about every one of us gets them.
https://bonesmart.org/forum/threads/post-op-blues-is-a-reality-be-prepared-for-it.7591/

 

[Jenn]

@donnag1108 I think you’ve said exactly what I feel, I want my life back. I want to be outside doing things in the yard and riding my motorcycle. I’m sorry you’re feeling this way. But I’m glad to know I’m in the “normal” range.

 

[sistersinhim]

 

[CorgiLover]

@donnag1108 Hang in there! Post-op blues are normal for this major surgery we’ve all had. I will be 9 weeks post-op this Thursday and experienced what you are going through. Believe me, it gets better as the body continues to heal!

My OS put my healing journey in perspective at my last post-op appointment, “Each day, week or month that passes look back and see how far you’ve come from your day of surgery, reflect on that and know it will get easier.” I’ll have to agree with him, while my good days are outnumbering my bad, it is indeed getting easier!

 

[donnag1108]

@CorgiLover thank you I needed that!!

 

[Jenn]

Today is definitely a day with blues. I had my 6 week post op yesterday and Dr was pleased with flexion but my extension is not as good. I am able to walk but with a little limp.

At therapy on Monday, I was at 104 and +8. Today at therapy, she pushed the flexion, extension and scraped. I was able to reach 107 and +6. I’m just so down about my progression. My OS mentioned that if I had not improved in three weeks, he may recommend a dynasplint. I’m doing exercises at home daily and I feel really defeated right now. I’m so worried I won’t be able to get my extension where it needs to be.

 

[Jockette]

6 weeks is too early to worry about your ROM, either flex or extension. This recovery takes an average of a year, 6 weeks is a drop in the bucket. Where you are now is not where you will end up.

My ROM continued to improve even after my one year mark.

I’m going to tag @Josephine for you.

 

[Jenn]

@Jockette my OS told me that if I didn’t work the scar tissue and got my number closer to 0, I would always walk with a limp. I’m the type to do what im told to make it better. But just feel defeated. I’ve been crying most of the day.

 

[Josephine]

DON'T believe him! It's NOT 'scar' tissue, it's just swelling and pain that is responsible, that's all. So your main focus should be to get the swelling down. Besides which, you are only 6 weeks out yet which is almost nothing!

I also noticed that you gave your extension as -8 which is incorrect. That's when the knee is hyper-extended or past zero. When you are unable to flatten the knee, the number is PLUS.


I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Jockette]

ut just feel defeated. I’ve been crying most of the day.

I’m so, so sorry your surgeon made you feel so bad. I don’t know how they can actually believe some of the things they tell us.

Answer Josephine’s questions and take her advice on board. She’s worked with joint replacement for many years and has had both her knees replaced. She knows what she’s talking about, and she cares very much for each and every one of us here on Bonesmart.

Extension took longer to regain for many of us, but we got it back, as you will, too.

 

[Jenn]

@Josephine I put -8 because tahts what my physical therapist tells me at each visit. I’ll be happy to answer any questions.

 

[sistersinhim]

my OS told me that if I didn’t work the scar tissue and got my number closer to 0, I would always walk with a limp. I’m the type to do what im told to make it better

Why oh why do they and PT have to tell people that when it's so untrue?! The harder you work your knee the more it swells. The more it swells, the worse your ROM is. I bet your OS hasn't had a tkr. He has done lots of replacements, but he isn't involved with the recovery. He sees a patient just every so often. Everyone of us has had a replacement. We have the experience of the day to day recovery. We know what works and what doesn't work. We just want to help others have the best recovery they can. There are thousands and thousands of experiences that goes into our articles. Please benefit from the years of experience that Bonesmart offers you.

 

[Jenn]

@sistersinhim thank you so much. No, my OS has not had a knee replaced. I don’t want to sound ungrateful with my new joint because when I look back months or even years ago, I was in so much pain and now the knee joint is pain free.

 

[Josephine]

I put -8 because that's what my physical therapist tells me at each visit.

Are you sure she's not just telling you "it's 8"? Here is an explanatory image that shows you how goniometry (ROM) works. Notice the red and blue flags

As for the questions, here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Jenn]

@Josephine I’m sure it’s negative number. It’s been negative since surgery.

1. Pain level is about 2-3 at it’s worse because of swelling and fluid. For the most part very tolerable

2. oxycodone/acetaminophen 7.5 mg every 8-10 hrs as needed

3. swelling is moderate

4. range today was 107 and -6

5. icing every hour to 2 hrs for 20 minutes each time

6. elevate about 30 minutes a day

7. I do light housework, laundry, sweeping, dusting

8. Exercise at home twice daily, 4 days/week
heel slides with strap for 3 minutes
without strap 3 minutes
leg hang with 1 lb weight for 3 minutes,
hamstring stretch 3 minutes

Exercise at PT, 3 days/week
Rotating back and forth with stretch on bike 5 minutes (not full rotation)
Calf raises, 3 sets of 10
Small squat 3 sets of 10
Calf stretch 3 minutes
Low step, 3 sets of 10
Heel slides, 3 minutes
Heel slides with strap, 3 minutes
Hamstring stretch both legs 3 min each
Leg raises, 3 sets of 10
Kick out with bolster, 3 sets of 10
Leg hang with 1lb weight, 3 minutes
Butt kicks, 3 sets of 10
Quad sets, 3 minutes

 

[Celle]

At therapy on Monday, I was at 104 and +8. Today at therapy, she pushed the flexion, extension and scraped. I was able to reach 107 and +6. I’m just so down about my progression. My OS mentioned that if I had not improved in three weeks, he may recommend a dynasplint. I’m doing exercises at home daily and I feel really defeated right now. I’m so worried I won’t be able to get my extension where it needs to be.

my OS told me that if I didn’t work the scar tissue and got my number closer to 0, I would always walk with a limp. I’m the type to do what I'm told to make it better. But just feel defeated. I’ve been crying most of the day.

Those ROM numbers are perfectly OK at your stage of recovery. Your main problem is that you have an impatient PT therapist and an impatient surgeon. They're both worrying you unnecessarily.

There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

And it's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

It's not at all unusual for extension to take longer to achieve than flexion. That's because the big muscles and tendons at the back of your leg have probably been a bit shrunken for a long time. Now they need to be stretched gently and slowly.
This article may help:
Extension: how to estimate it and ways to improve it

Here are a couple of examples from people who gained ROM slowly, but they got there in the end:
This is what Campervan wrote. As you can see, her flexion continued to improve for a long time.
"I had a slow recovery. Here's my flex measurements at various points:
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months
128 – 6 years "

This is from bertschb:
I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.

 

[Jenn]

@ Celle Thank you! After reading ROM from other participants, I am okay. Thank you again. I’m a very impatient person and each day I’m realizing that this is my lesson.

 

[Josephine]

I’m sure it’s negative number. It’s been negative since surgery.

It can't be! No knee is capable of obtaining -8 degrees of extension! It just can't be done! +8 degrees means you can't get your knee flat at all!

Besides, your doctor confirmed that I am right!

Dr was pleased with flexion but my extension is not as good.