TKR Knee Wobble Question

[Jockette]

I see I confused folks with my verbiage. By "assistance" I mean me bending it. By unassisted I mean only my leg all by itself under it's own power.

Our point is, this is all you need to do, what you can do totally on your own power.

Using a strap, or sheet (like I was told to do) or anything else, to assist you to more of a bend, that you can’t do in your own power, isn’t necessary, to get your ROM back.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

People are all 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. So, if I using something to assist your bend is not causing any additional pain or swelling, then that‘s ok. We just don’t want you to think you must do something to help you bend further than your healing knee is ready for. Given time, the swelling will go down, and your bend will be there.

 

[HokieGCC]

Minor update and a question if folks don't mind sharing their experiences.

I backed off the PT a lot. All I do now is two walks a day and 2 to 3 times stretching for ROM. By the numbers I am doing well at 4 weeks. With quite a bit of loosening up I can hit 0/120 and am able to walk pretty long distances. I am also driving.

However ... my biggest issues are: (1) I still have still the tourniquet feeling when I walk and (2) I can spend 5 minutes working my way up to a good stretch (120-ish) but literally just a few minutes afterwards I tighten right back up. So even though I can reach 120 degrees I am really only functioning at around 90. Is this just the way it goes in that your functional flex lags your "stretched-out" flex for a while? My swelling is going down some at night now but returns with activity.

This coming week I transition from home PT to driving to PT. I will also discuss with them. Thank you in advance!

 

[Jockette]

You may have the tourniquet feeling for a while. Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.

Being able to get to that 120 proves it’s there, and you will get to a point where you maintain it, after more healing takes place.

 

[HokieGCC]

Thank you @Jockette.

I suspected such but hearing it from those that came before me is very helpful.

 

[kneeper]

You're doing well! Don't worry, that stiffness will decrease as you heal.

 

[HokieGCC]

Hi Folks, I am an admitted "Google Doctor". I know it is bad for me but I can't help it. I found an interesting NIH study.

Target range of motion for rehabilitation after total knee arthroplasty - PMC

Objective: Postoperative knee range of motion (ROM) is among the most important factors influencing patient satisfaction after total knee arthroplasty (TKA). The purpose of this study was to clarify the time course of improvement in knee ROM up to ...

www.ncbi.nlm.nih.gov

This study determined that flex does not improve on average after 3 months post-operation. There is a nice plot and table with the data. They don't try and answer the "why".

I can imagine two possibilities:

1 - It's medical. The knee heals and becomes much harder to stretch after 3 months (or somewhere between 1 and 3 months ... more on that later).
2 - People become satisfied with their flex and overall better situation and stop trying to increase it.

It is interesting to note that the average pre-op flex is 118.5 degrees and the average post-op flex is 112.1 degrees at 3 months and 113.6 after a year. So on average people lost 5 degrees having a TKR.

One other observation...it is not clear if things flatten out a 3 months or somewhere between 1 month and 3 months. It appears to me that this may really mostly flatten out more like at 2 months. Some literature says 6 weeks so this supports that claim.

 

[Jockette]

This study determined that flex does not improve on average after 3 months post-operation.

This is a very small study and maybe the people they studied didn’t gain much ROM after 3 months, but many of us here in Bonesmart have, I am one of them, as is @FCBayern.

3 months post op is only 25% healed, in this recovery that takes an average of a year. Many of us still have swelling at 3 months, which definitely limits ROM. As swelling goes down and we continue to heal, ROM increases. In fact, my ROM, which came very slowly the first year, continued to improve in my second year, as I continued to heal and my whole leg relaxed. I even saw improvement with my ROM in my third year post op.

 

[HokieGCC]

@Jockette that is really good to hear!

 

[Sisterpat]

My Sister gained flexibility well into a full year if not further!

 

[GiantFinnegan]

Most of my family over 45 yrs old on my mom's side has had at least one knee replaced (yay, bad genes!) and they've all told me that their ROM continued to improve over the course of a year, and some of them said into their second year. And other friends and relatives have told me the same thing. Of course my family is not a formal study, but I'm happy to have their anecdotes!

 

[kneeper]

I didn't gain dramatically after three months but did gain several degrees.

My OS said the best predictor of post op ROM is pre-op ROM, but I did gain a little bit between 3 months and 6-12 months. (I had decreased bend for many years before my surgery so a lot of it I think was gradually stretching the muscles etc. over the recovery months to allow for the bend.)
I didn't measure or anything, but I would realize I could bend more when I did daily activities that required bending.

I didn't do" boot camp" PT or anything, but I just kept moving.

 

[HokieGCC]

Hi Everyone, I sure appreciate your comments.

I do have another question. I am in my 6th week now post-op. As measured I am able to achieve a decent flex (~120). However, unless I am actively flexing my knee it turns stiff. Also, I do not "function" anywhere near the 120 degrees as measured. I probably have 90 degrees of function.

My question: Is this normal and can I expect my functional ROM to approach my measured ROM over time and the stiffness will go away? or, is this a sign of a problem?

When I search the internet for "stiff knee" they are always talking about not being able to bend at all...but that's not my problem.

 

[Jockette]

Here’s a good explanation of the stiffness we have for a while after this surgery:

Stiffness/Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.

And I definitely agree with you about the ROM number and the function of that number. I always felt the same way. My surgeon was a fan of pushing my bend to a painful level to get the best number he could get, but I always felt it was a false indication of my progress as I didn’t have the function. (Thanks to him and my PTs I have a bit of PTSD from my replacement experience. )

Yes this stiffness will lessen in time as you heal, and that timeframe differs for each of us.

 

[HokieGCC]

Thank you @Jockette!

 

[GZGirl22]

Thank you so much for your help. I am glad to hear that the tightness will eventually go away. It is pretty intense at the moment. If it weren't for the tightness I could go on longer walks pretty comfortably. As it is I just cover a couple tenths each day hoping I can go for longer walks over time.

I made the mistake of trying to up my distances too quickly years ago when I had simple meniscus repair. At 2 months I was really frustrated with my lack of progress. Surgeon told me that the knee needed to HEAL and REST or it would never get me back to hiking with me constantly causing new inflammation. I am having a really good ride post op but am careful to up my daily steps by a couple hundred at a time every couple of days. I learned the hard way that just because I could get out there and walk distances doesn;t mean I should. Patience was the hardest part for me to learn. Healing and rest now will mean better ability sooner rather than later. ;)

 

[HokieGCC]

Hi Everyone,

It has been a little while since I posted. I just passed my 11 week post-op. Many things are good but I have one large concern. Here is the good - My ROM is a little better than 130, I am able to ride my bike a little and walk pretty good distances. I have been released from PT. They say I am in the 95th percentile in function at this point in time.

My concern is that when I flex my knee a bulge develops on the lateral (outside) of my knee and I have perpetual swelling there as well. My Doc says it is fluid inside my knee that when flexed it builds there. To me it feels way too hard to be fluid. It feels like it is my actual knee and constantly irritates a tendon in the area. Thats what it feels like anyway. This bulge has been there ever since the surgery and shows no sign of reducing or going away. By evening I can feel some neuropathy in my toes that seems to be coming from that nerve that passes by that area near the bulge. Also, I am icing lots and lots still and taking Aleve at times trying to combat this.

Is it possible that they used a femur component that is too large?

Has anyone experienced anything like this?

Thank you very much.

HokieGCC

 

[Jockette]

My Doc says it is fluid inside my knee that when flexed it builds there.

I had that same lateral bulge and sensitivity but it went away as I healed. I forgot about it until you just mentioned it. Sometimes I could actually feel the swelling burst into that spot. I had a Patellofemoral partial, my one “little” implant is only on the front end of my femur, so I don’t have all the hardware you have, so I doubt it’s due to having too big a component. I think your doctor is right.

 

[HokieGCC]

Thank you @Jockette. I hope you are right. It sure feels like a bone.

 

[HokieGCC]

Well I am meeting with my Doc on Thursday and a second opinion Doc on Friday. My surgical knee is every bit of a half inch larger (wider) than my non surgical knee. I don't think it is swelling either.

I am really starting to suspect my knee parts are oversized.

 

[patriciad]

In your photo your whole leg looks larger more swollen !
Did your OS show you your X-rays and explain the reasons for the diagnosis of swelling? He should do that if he hasn’t already. With my first RTKR - I had no idea of the extent of tissue damage involved as was focused on the prosthetic. I was shocked when some months out I had to have a steroid injection for ongoing bursitis in the operated knee. Hopefully this is something similar and your worry about an ill fitting joint will be put to rest after seeking a 2nd opinion.