TKR kneeidea63's TKR Recovery Thread


junior member
Aug 16, 2014
United Kingdom United Kingdom
As it turned out the denture didn’t arrive on time so I was in and out of hospital before it appeared. I had my surgery as a “toothless crone”, but decided I could live with that.
I came out of hospital exactly two weeks ago. All went well; I had the spinal I wanted, out in under 3 days, and have just had my clips removed this afternoon.
Lessons learnt from last time are being applied in hope of a more relaxed recovery.
I'm glad things turned out well for you, @kneeidea63 .

Here is your recovery reading:
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:
take your pain meds by prescription schedule (not when pain starts!)​

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. At week 4 and after you should follow this

6. Access to these pages on the website

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
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Wishing you the very best as you continue to recover! I'm not sure a 'second' TKR is any easier to recover than a first, lol, but I do know time heals! You're just over a week behind me in my recovery and it's been a mental challenge for me during the Holidays. But I'm very soon to be a month into it and that's encouraging! Pamper yourself as best as you can! Hopefully we'll be up and running by Spring!

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I'm glad all went well, even though you didn't have your denture. But, even if you had had it, you would have had to remove it for the surgery, so no harm, no foul, as they say. Good luck on a continued great recovery and please keep us updated.
I hope you find those lessons learned helpful. I felt well-served by my prior experience with knee surgery. This is pretty darn slow, but not wholly extraordinary, compared with my ACL reconstruction years and years ago. Still grueling, but manageably grueling.

Good healing to you!
The attitude of physios here seems to have changed to a more relaxed approach to recovery in those 5 years. Research, understanding and patient rights have changed.
I pushed hard to get my ROM with the right knee and consequently had a lot of swelling and pain and very slow progress, it took months to get the swelling down.
This time I’ve focussed on resting and reducing the swelling, and taking it slowly. I find heel slides difficult and too much or too many cause pain in the ligaments at the back of my knee. Bonesmart has taught me not to do anything that actively increases pain and swelling, so I do little and often rather than intensive exercising.
The physios are a little concerned that after 6 weeks I’m only at 85, but they aren’t pushing me. Compared to last time I’m experiencing much less pain, the swelling is gone, my walking is good. The consensus is “that’s the way your knee is, and like last time it’ll probably take longer to get a decent ROM”.
(With both knees I had a 0 extension in 5 weeks)

Please don’t let a physio push you and set your recovery back.
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I've copied the above post from Roobear's thread.

As well as helpful for him, it's a useful update about your own recovery too. It's good to know you're doing well.
Thank you, @Celle . I keep meaning to do an update.
Thank you @Suz, @lovetocookandsew, and @Helizabug for your support.

I see my surgeon this afternoon for my 6 week check up, although it seems so much longer than that since I had surgery. I’m hoping I have to chance to discuss the posterior ligament pain and get his take on my slow ROM development.
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Nice to see you! I saw your post on Roobear’s thread and wondered how you are doing. I see my surgeon today too.
Good luck with your appointment today. It sounds like you're doing well.
So, it’s three weeks since I had my follow-up appointment with my surgeon, and saw one of his registrars, rather than the man himself, although I could hear him behind the scenes. I’ve taken some time to assimilate what was said there and at my last physio appointment. In summary he said:
New joint is good, well positioned and surgery went well.
Healing is good, quads are strong, extension is good.
The pain at the back of the knee is ham-string and will improve as my extension gets better (extension was at 0 and has been for some time, so I’m not sure about that).
Flexion is poor, but not uncommon in “younger” patients like me (62!)
I should be using a stationery bike to improve flexion.
My physio should be pushing my leg to increase flexion.
My physio should be pushing down on my knee to increase extension.
I should use my other leg to push back the new knee to increase flexion.
He would see me again in 6weeks, to see how things were going.

I asked him to repeat some of the exercise instructions so I could pass them on to my physio correctly and took notes immediately I left the department. I felt positive that I wasn’t being left with a poor ROM, but was a bit wary of some of the instructions.
Surprisingly, my knee felt a bit freer the following day. After all the pushing and pulling he did I was expecting a lot of swelling!

3 days later I had a physio appointment. Due to the cancelling of electives over Christmas I had the physio to myself, rather than the normal group session, so we were able to go over everything that the registrar had said. The physio was quite sceptical about his understanding of how post-surgery physio operates in the NHS (he trained in Belgium) i.e it is designed to give the patient a set of exercises and the confidence to do them at home. The NHS hasn’t got the capacity, and Physios are not “hands-on”, you can’t expect to achieve big changes in 4 fortnightly sessions.
She actually did some of the manipulations suggested, but advised me that there was no obvious reason why I couldn’t get a reasonable ROM over time doing the exercise programme and keeping at it, given the experience of last time. She certainly didn’t think I needed to be considered for an MUA yet. She suggested I could pay a private physio to push and pull, but would need it at least three times a week for any appreciable change, which would be expensive. I’m guessing that this is the kind of physio so many US patients talk about on here, and that it’s covered by insurance. I did go to a private physio when I was despairing of my right knee 5 years ago, but they were useless, only prescribing exercises I was already familiar with rather than performing any manipulation. I wasted my money.
She told me to keep off the stationery bike as it isn’t a good position for the new knee joint, and there is a tendency to lift your hip to get the pedals round. So I’m sticking to my mini-pedals!

I came away from that physio session calmer and more optimistic about my knee, even though flexion, at 87, is still less than when I left hospital. I took away positives that I’m walking well, my extension is good, there is time to get a better flexion, it’s normal to take months to be able to do stairs in cadence, and that it is not so bad that an MUA is recommended.

Since then I’ve had downs, probably post surgery, stuck in the house blues, but I feel brighter now and am feeling positive.
After my last post I revisited my posts from my first surgery and realised that the flexion on my left knee is MUCH worse than the right knee was in the first two months: 115. However, the right knee went rapidly backward as I pushed too hard, and trained rather than recovered. So, at three months I’m probably in a similar position, BUT, my left knee isn't horribly swollen, nor anything like as painful. However, I know that I’ve been focussed on “activities of daily living” for a few weeks, and not really following a programme of exercises.
So I got down to business with the pedals and I’m happy to report that my flexion has improved enough to drive my car and to walk up stairs.
Driving isn’t difficult as I have an automatic, but getting out of the car in car parks is the limiting factor.
Walking up stairs isn’t pretty, but it’s getting better, gradually.
The next goal is to be able to cycle on my exercise bike; I’m still only able to rock back and forth, even with the seat on the highest setting.
There is this PT woman, where I go twice a week, whose husband had TKR the same day as me, its hard not to compare our progress- She said they work out at 6 am every morning and she really pushes him- he has 0 extension and his ROM is at 135-yowza, its was hard not to feel a bit jealous, I am more like a turtle, making tiny improvements every time I go to PT and get measured-well, imagine how surprised I was today when she told me his knee is swollen so bad with fluid, they will have to drain it and he is in a lot of pain now- I felt really bad for him and have to admit, not as jealous of his superior progress anymore-So, I think Bonesmart has it right, slow & steady & manage the swelling and it will all work out., eventually.
Hi @Peaches0000, yes, it’s so easy to look at other people and make negative comparisons about your own progress. The woman in the next bed to me in the hospital, same op, same surgeon, was doing so much better than me at bending her leg, but , I was doing much better than her straightening. It took me a long time to get a good bend with my first TKR, and I try to remember that when I get frustrated. I’m having a good day today.
Yesterday I had another check up. A different registrar from the last one (the surgeon is on holiday) and what a difference. This chap was gentle, no aggressive pushing, and very positive about my progress. And there has been progress. My knee is now beyond 90 degrees flexion and the extension is at least 0. I was sent off with instructions to keep up the exercises and it will work out; leg straightening is good and that’s what matters first; flexion is fine and he’s happy now it’s beyond 90. (It was 85 at my last appointment 6 weeks ago).
I won’t be seen again until the anniversary of my surgery, in 9 months.
In the last two weeks I’ve been able to walk up the stairs here in cadence; which is quite something as the risers are over 6 inches in height. So I’m feeling much more positive about my potential and if I feel I’ve done too much any day I rest the following day and focus on icing and elevation. Slow and steady.
It's now 9 months since my second TKR.
As Bonesmart tells us no two knees are the same, and over the last few months I've learned that. My right knee was reluctant to flex, but my left knee has decided to top that. On the positive side, as I wrote in March, I have at least 90 degrees of bend, and my extension is fine, and probably in minus figures. however, getting any further than 90 is proving difficult and slow.

I decided that ADL was the way I was going this time, rather than giving myself pain, a swollen knee, figures going backward, and much mental anguish, as happened 6 years ago when I tried to get the best bend and fastest recovery. Covid-19 and then UK lockdown came just at the wrong time for me, I could drive and I was ready to get out, live a normal life, walk by the sea and recover. It was not to be; here I am, 6 months later still in my partner's house, rather than my own, as we continue to isolate (my partner has a compromised immune system so we rarely leave the house). We've done lots of gardening, and I feel fit and pain-free, but I think I've adapted rather than recovered. I can walk upstairs reasonably well, but down is pretty poor, and I certainly can't turn the pedals all the way around on my exercise bike. There's definitely an improvement since March, but not a lot.

When my partner said that it looked like I was storing up problems for the future, as I made my way downstairs three days ago, I decided to go back to exercise basics; sliding my foot lying in bed, doing wall slides, lunges, and squats; the results were interesting. I have some pain, and some swelling, so my sleep is affected, but I'm also aware of feeling some increase in ROM.
So, I'm looking for some advice. Am I imagining improvement because I want it/need it? Is it still possible to improve things after 9 months? Is going back to pain, swelling, and lack of sleep worth it?
Am I imagining improvement because I want it/need it? Is it still possible to improve things after 9 months?
Is going back to pain, swelling and lack of sleep worth it?
sliding my foot lying in bed, doing wall slides, lunges and squats
You don't need swelling etc. Back off and do no strength work, just mobility stretches.

If your leg is stiff and swollen then using an exercise bike for training is not a good idea; but you can still use one for mobility exercises - even if you can't make a single rotation!

  • Set the bike to zero resistance
  • Set the saddle as high as possible and rock the pedals back and forth as far as you can with discomfort but no pain
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
Here is a bit more chat and some pix and how 'healing' and 'training' are different
Thank you @Roy Gardiner for the encouragement. My exercise bike doesn’t have a great seat range, so I’ll be rocking back and forth for a while. I can only get a full circle if I stand on the pedals off the seat. I also have a set of pedals I need to get back out. The “chat and pix” were interesting, I wonder if, despite feeling that my extension I’d good, I’d benefit from picking up those exercises too.
It can progress even at this time. Just like at the beginning, slow and steady is the way. Add a few moves and see how your knee reacts. Stay there for a few days before adding more and again watch for any reaction. After exercise don't forget to ice and elevate just like in the beginning of recovery.

You can do this after all with Covid what else do we have to do. Like you I do not go out much at all so staying in and working on gardening and other activities. Have a peaceful day. :flwrysmile:

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