BoneSmart® Hip / Knee Replacement Forum
Joint Replacement Patient Advocacy
and Online Community
  1. Announcing BoneSmart's NEW Joint Surgeon Locator tool

    We are pleased to now offer a tool to help you find just the right surgeon for your needs. If your surgeon is not listed, please let us know and we'll get them added.

    Read more about this in this announcement:

    Dismiss Notice

[TKR] Knee gives out

Discussion in 'Knee Replacement Recovery Area' started by dmjacks1, Dec 18, 2018.

  1. dmjacks1

    dmjacks1 new member
    Thread Starter

    Member Since:
    Dec 18, 2018
    Age:
    53
    Messages:
    10
    Gender:
    Female
    Country:
    United States United States
    Hello. I’m at 10 weeks from a TKR. My PT is all concerned with the ROM that I’m obtaining. He was stating that if it doesn’t get farther then they will manually manipulate the knee, which he doesn’t like because it almost puts you back to the beginning.

    I worked at it, forcing it and, at week 10, got a ROM of 115 degrees and a -3. They also think there is scar tissue.

    My question is this: if there is scar tissue, how far does the knee have to bend to break it up?

    I have felt tinges, but nothing major. I’m beginning to believe the issue I’m having is an extremely tense quad. I can’t get the thighs muscle to relax most of the time. It relaxes when I put the heating pad on my thigh, but tightens up not long after removing it.

    Thank you for any answers.
     
    • Agree Agree x 1
    • Useful Useful x 1
  2. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

    Member Since:
    Jul 23, 2011
    Age:
    67
    Messages:
    6,187
    Gender:
    Male
    Location:
    Essex and London
    Country:
    United Kingdom United Kingdom
    Your ROM is fine for 10 weeks. YOU decide on MUA not them; they recommend. If you have scar tissue (more accurately, adhesions) the surgeon bends your knee as far as needed to 'snap' the stuck tissues. This is too painful to do when awake, and indeed sets you right back to the beginning. But it's most unlikely, especially at 115 degrees, that you have it. Wait and continue gentle stretching, IMO

    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
    5. Here is a week-by-week guide for Activity progression for TKRs


    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 a 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 history before providing advice.
     
  3. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

    Member Since:
    Oct 31, 2016
    Age:
    66
    Messages:
    6,326
    Gender:
    Female
    Location:
    Philadelphia
    Country:
    United States United States
    Hi @dmjacks1 and :welome: You've come to a community of people who've all had joint replacements and we know what you're going through because we've gone through it ourselves.

    Chances are, with flexion of 115 at 10 weeks, you don't have scar tissue in need of breaking. What you probably, almost certainly, have is swelling in needing of being reduced. You can have swelling in the small spaces of the knee joint that's not visible, and it will impede your bend. Your extension is just fine!
     
    • Agree Agree x 1
    Last edited by a moderator: Dec 18, 2018
  4. skigirl

    skigirl FORUM ADVISOR Forum Advisor

    Member Since:
    May 5, 2009
    Age:
    75
    Messages:
    13,611
    Gender:
    Female
    Location:
    Minneapolis, MN
    Country:
    United States United States
    Yes, a rom of 115 is actually quite good for 10 weeks. The problems you are encountering are BECAUSE of your PT!! he/she is forcing your knee bend and in doing so is causing trauma and swelling in your soft tissues. I would recommend you ask for a new PT---one that has had training in TkR recovery within the last five years. Your PT is old school and is so far behind the times, it is silly really.

    So, think of your knee as a garden hose---if it is full of water can you bend it? can you force it to bend? or, do you just put it down, let the water drain away and then bend it? it sounds like you have some swelling--the best treatment for that is rest, elevation and ice.

    At ten weeks my OS told me that I should be resting one full hour for every two hours I was up and about. That rest hour was in bed or on the couch with my leg elevated. You need to stop worrying about your bend. Most OS will not even do a MUA if you have more than 90 rom--which shows you how much your PT actually knows.

    Right now, take a few days, rest, elevate, take it easy--no FORCED bending at all. At the end of the few days how does your knee look? Better? than there is your answer. Sometimes your own common sense is better than a person who professes to be an expert.

    TKR: Ceasing aggressive physical therapy after surgery

    In-Patient Rehab Not Always Needed After TKR

    Efficiency of immediate postoperative inpatient physical therapy following TKR

    Elevation is the key to controlling pain and swelling
     
    • Agree Agree x 1
    • Useful Useful x 1
  5. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

    Member Since:
    Jun 8, 2007
    Age:
    78
    Messages:
    84,911
    Gender:
    Female
    Location:
    The North
    Country:
    United Kingdom United Kingdom
    Pretty good? It's EXCELLENT!

    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?
     
    • Agree Agree x 1
  6. Spex10

    Spex10 post-grad

    Member Since:
    Dec 3, 2016
    Messages:
    1,481
    Gender:
    Female
    Country:
    United Kingdom United Kingdom
    Yes! Sack your PT. You're doing fine!
     
    • Agree Agree x 1
  7. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

    Member Since:
    Dec 4, 2015
    Age:
    68
    Messages:
    18,058
    Gender:
    Female
    Location:
    Virginia
    Country:
    United States United States
    115/-3 ROM is fantastic for 10 weeks! Don't let your PT tell you it's not. He wants you to have a MUA so you'll keep coming back and paying them for their services. You are the boss, not PT. They have to do what you say. Actually, with ROM like that, you don't even need PT unless to work on your gait. Your ROM will continue to improve for a year or more just doing your daily activities.
     
    • Agree Agree x 2
    • Useful Useful x 1
  8. dmjacks1

    dmjacks1 new member
    Thread Starter

    Member Since:
    Dec 18, 2018
    Age:
    53
    Messages:
    10
    Gender:
    Female
    Country:
    United States United States
    Josephine, yes you can ask me questions and I will answer honestly. I appreciate all advice I can get.
     
  9. DIYSteve

    DIYSteve member

    Member Since:
    Jul 8, 2018
    Age:
    63
    Messages:
    142
    Gender:
    Male
    Location:
    Washington
    Country:
    United States United States
    115/03 at 10 weeks: good numbers, don't fret it. What is it with some PTs and keeping score with ROM numbers? With my PT at 10 weeks it was primarily about function, specifically proper gait and adequate extension to allow same.
     
    • Agree Agree x 1
  10. Dolly Girl

    Dolly Girl junior member

    Member Since:
    Dec 22, 2018
    Age:
    66
    Messages:
    83
    Gender:
    Female
    Country:
    United States United States
    Oh my, I am full of opinions.
    Stop PT
    Refuse to discuss MUA
    Be thankful for your fabulous 115 degrees
    Rest, your range and strength will come back from daily living and moderate walking.
     
  11. maximummy

    maximummy new member

    Member Since:
    Oct 26, 2018
    Age:
    63
    Messages:
    14
    Gender:
    Female
    Location:
    Hertfordshire
    Country:
    United Kingdom United Kingdom
    These PTs do get on my nerves! You are doing absolutely brilliantly! They mess with your confidence so much.

    I had my right TKR on October 29th. I had the left done four years ago. This is what I have learnt ... or at least, what is right for me!
    I had two sessions of aqua therapy during my stay in hospital. I had two more once home and one ‘dry’ therapy after that. Doing fine .... 100 degrees at three - four weeks. Then I ditched the hospital PT and have just tried to resume a normal life .... plenty of rest and trying to walk around the house, short trips out, a bit of visiting and having visitors. I can just about, with effort, get up some of the stairs normally, but not yet tried to come down As I know for sure I can’t yet. I can now stand long enough to cook a meal, do a small amount of shopping, eat out a bit and go to the cinema ... baby step to raise my leg goes everywhere with me and I take ice packs to a house.
    I had a long chat with my GP to gradually reduce strong painkillers without denying myself what I need, when I need it and I am managing. I still use the Cryocuff, but less than I did. I am, for the most part, sleeping through. I am sometimes uncomfortable ... real pain is transient now. I know I am exceptionally lucky ... and I know, because last time was a totally different scenario and I was petrified of having the second knee done.

    DO THINGS YOUR WAY ...it all takes time and 10 weeks is early days.
     
  12. Celle

    Celle FORUM ADVISOR Forum Advisor

    Member Since:
    Nov 19, 2011
    Age:
    77
    Messages:
    33,815
    Gender:
    Female
    Location:
    New Zealand
    Country:
    New Zealand New Zealand
    PTs get obsessed with numbers, because they are something tangible that they can report to the insurance companies that pay them.

    That doesn't mean that you have to worry about your ROM. It's really great for so early in recovery, and surgeons almost never do an MUA unless your flexion hasn't reached 90 degrees. You're way past that!

    In any case, 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

    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.

    PS: Please tell us the full date of your TKR and which knee ti was, so we can make a signature for you. Thank you. :flwrysmile:
     
  13. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

    Member Since:
    Jun 8, 2007
    Age:
    78
    Messages:
    84,911
    Gender:
    Female
    Location:
    The North
    Country:
    United Kingdom United Kingdom
    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?
    ai63.tinypic.com_eta39s.jpg

    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.
     
  14. dmjacks1

    dmjacks1 new member
    Thread Starter

    Member Since:
    Dec 18, 2018
    Age:
    53
    Messages:
    10
    Gender:
    Female
    Country:
    United States United States
    @Josephine , my surgery was 10/10/2018 and it was my right knee.

    1. My pain level right now is about a 3-4. However, when the weather changes and it’s going to rain it raises sometimes to a 5. The muscles are super tense and tight around the knee and in my thigh and they won’t relax.

    2. I was on Meloxicam but have weaned myself off and now only take either aspirin, Tylenol, or Naproxen.

    3. My leg has only ever been moderately swollen. I’m lucky there, as my body never swells much, but it also makes it hard for me to tell doctors the amount of pain when there isn’t a lot of swelling for them to see.

    4. My flex action is 115 and extension is -3.

    5. Yes. I ice when my knee feels irritated, or it swells. I also ice when the pain sets in or it starts to become super stiff. I ice for an hour or more while elevating my leg.

    6. I just recently started elevating my leg, and I leave it elevated for an hour each time. I elevate it when I ice, or when my knee starts feeling bad. Funny, my surgeon was against anything under the knee, or elevating because of DVT.

    7. I am now quite active and have been. I clean house, cook, do the shopping, etc. it’s just at a much slower pace than it used to be.

    8.
    Ankle pumps: whenever I’m sitting still
    Leg lifts 3 sets x10 twice a day
    Lunges 1 set x25 once a day
    Lunge where back leg bends and body lowers like a sit position: 1 set x25 once a day
    Sideways leg lift 1 set x25 once a day
    Stair lift (foot on stair and raise rest of body up to stair on same level): 1 set x25
    Ball squeeze (squeezing a ball between my knees): 1 set x25
    Ball push (pushing on a ball between my right leg and chair arm) 1e set x25
    Wall bends (laying on your back with legs extended on wall. Then using good foot over the foot of bad leg as a weight to bending it further) holding bend for 15 seconds x5 sets. This one I do every other day.
    squat where you bend knees and back is straight like you are going to sit in a chair while holding counter for support 1 set x25 once a day.

    Now, I can vary these but I do most daily, except for the wall bends.

    I am no longer in PT. Insurance ran out and now too much in out of pocket in new year.

    A few things I have to let you know. About a year and a half ago, I was diagnosed with psoriatic arthritis, so I’m in constant pain. I will be returning to work for only 3 days a week at Walmart starting February 3.
    I am now walking an outdoor park trail to help build up the strength in my knee so I don’t die the first day back!

    Hopefully I’ve described the exercises enough. There are days that I don’t do them at all because the fatigue from my psoriatic arthritis just is too much.

    Thanks for any help.
     
  15. Larryhg3

    Larryhg3 senior

    Member Since:
    Mar 5, 2018
    Age:
    53
    Messages:
    282
    Gender:
    Male
    Location:
    Connecticut
    Country:
    United States United States
    Welcome to BoneSmart. We actually share the same surgery date. Currently your ROM is better than mine. I think that the difference is that my PT knows better than to use my ROM as a threat. It was one of the ground rules that I set on day 1. I will not be driven by a number period. My focus is on functionality and no longer having pain not on a number. I often ask myself if I had the surgery because my ROM sucked (which it did pre surgery) or if I had it to no longer have that constant grinding pain? The answer is easy. Until I had my surgery I never even Thought about my ROM. So now that I have gotten rid of the pain why should I be focused on something I never worried about? I personally believe in and use PT as a tool to regain strength that I lost through decades of pain and to relearn the right way to do things like, walk with a normal gait, go up and down stairs leg over leg and live a pain free life. Just another perspective on ROM
     
    • Agree Agree x 1
  16. dmjacks1

    dmjacks1 new member
    Thread Starter

    Member Since:
    Dec 18, 2018
    Age:
    53
    Messages:
    10
    Gender:
    Female
    Country:
    United States United States
    Thank you Larryhg3. Not only do we have our surgery date in common but we are the same age!

    I too am trying to use these exercises o strengthen my knee. I have to return to a job where you spend 7 hours on your feet but only going back three days a week. Don’t know how much I will be able to take of that, but we will see.

    The ROM numbers never bothered me until they started talking manipulation. That I didn’t want.
     
  17. Larryhg3

    Larryhg3 senior

    Member Since:
    Mar 5, 2018
    Age:
    53
    Messages:
    282
    Gender:
    Male
    Location:
    Connecticut
    Country:
    United States United States
    I would be astounded if you OS would even consider an MUA with your current ROM. But if they did you have the right to refuse and you should plain and simple. Good luck getting back to work for me that has been key in both knees. Adds normalcy back to my life and keeps me from spending all my time focused on my knee
     
    • Like Like x 1
  18. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

    Member Since:
    Jun 8, 2007
    Age:
    78
    Messages:
    84,911
    Gender:
    Female
    Location:
    The North
    Country:
    United Kingdom United Kingdom
    Before I get to your responses, what on earth made you think you needed to 'wean yourself off' Meloxicam?
    Do you think people get addicted to it?
    For what purpose are you think you are prescribed aspirin?
     
  19. dmjacks1

    dmjacks1 new member
    Thread Starter

    Member Since:
    Dec 18, 2018
    Age:
    53
    Messages:
    10
    Gender:
    Female
    Country:
    United States United States
    Josephine, it was my third prescription and it truly doesn’t do anything for me. Honestly, the aspirin works better. The aspirin isn’t a prescription. It’s just what I use. I have to be careful with what I take with my psoriatic arthritis meds and the doctors won’t prescribe me anything stronger. Thus, this is where I’m at.
     
  20. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

    Member Since:
    Jun 8, 2007
    Age:
    78
    Messages:
    84,911
    Gender:
    Female
    Location:
    The North
    Country:
    United Kingdom United Kingdom
    Okay, well aspirin is an NSAID and as I understand it, NSAIDs are not recommended to be used with PA.
    I suggest you try using Tylenol 1,000mg 3-4 times a day at 6hrly intervals.

    Okay.
    I can imagine and I feel for you.
    That is superb!
    Good.
    He has his opinions misguided. Read this which was in among the articles left in the Recovery Guidelines in the third post of this thread. So I take it you haven't read them?!!
    Jolly good!

    Ankle pumps - you don't need to do these any more because you are fully mobile
    Leg lifts 3 sets x10 twice a day - again, once you can do these, you don't need to do them any more!
    Lunges 1 set x25 once a day - with flexion like yours you don't need these!
    Lunge where back leg bends and body lowers like a sit position: 1 set x25 once a day - same here!
    Sideways leg lift 1 set x25 once a day - and here
    Stair lift (foot on stair and raise rest of body up to stair on same level): 1 set x25 - and here
    Ball squeeze (squeezing a ball between my knees): 1 set x25 - and here
    Ball push (pushing on a ball between my right leg and chair arm) 1e set x25 - and here
    Wall bends holding bend for 15 seconds x5 sets. This one I do every other day. - also unnecessary
    squats 1 set x25 once a day - and these

    Oh look!I've crossed out ALL your exercises! That's because they are not necessary. Your ROM is excellent.
    I'm very pleased to hear it!
     

Share This Page