TKR Larry’s LTKR Recovery

[Larryhg3]

Good morning all,
I began my PT yesterday with a very frank conversation with my new Therapist. We agreed that there would be no assisted ROM measurements. I explained that I have already pushed myself too hard without anyone assisting. Yesterday’s session was challenging but I was able to recover from it with elevation and ice. I have some at home exercises to do a couple times a day but nothing overly trying. Basically I was clear, I am the one who has to deal with the pain after they push and I am not okay with that. Time will tell.
I also returned to work from home yesterday which has been great for me mentally. I was beginning to go a little stir crazy and having something to keep me occupied is great. I have Alexa remind me to get up and move every 40 minutes so I can walk my house for 5-10 minutes. I have worked out a way to sit with my leg elevated during conference calls.
One question that I did have that I haven’t asked yet. Like most of us they have beat the don’t put anything directly under your knee drum at me non stop. For elevation I have been doing a 3 pillow stack, as directed by my PT. However, I have seen several people here who use and love the Lounge Doctor pillow. Is it safe to use a pillow like that? Do any of you who use it use it at night when you sleep?

I have to say I am so very grateful to have found this forum. You all speak from actual experience. Nobody has judged me because honestly I have always thought that I had a high pain tolerance and was strong mentally, but most days I find myself thinking what a big baby I am.

 

[Beckadeez]

You’re not being a baby. This recovery is very hard at times and very trying, emotionally. Never know what will happen from day to day. For me, that’s kinda scary. Your emotions will be all over the place. Cry when need be and down the road it’ll get better.

 

[sistersinhim]

The Lounge Doctor is fine. Many of us have used it and rave about how good it is.

 

[Larryhg3]

This week has gone pretty well I hit 4 weeks post surgery on Weds. My pain is pretty much gone I take 1 pill at night only and that one is going away soon I think. I have had 3 PT sessions this week. I come out of them exhausted physically and a little uncomfortable but not to the point of pain. I have managed to get out on my 20 minute walk twice this week with no ill effects. I do my daily extension and flexion exercises twice a day (once on days I actually go to PT). Yesterday we drove to my in-laws church for a St Paddy’s day dinner total time out 5 hours. Again exhausted and a little uncomfortable but not painful. I feel good and am hoping for way more days like this. Seems weird that the PT and doctor are all focused on flexion and extension number, I stopped stressing on those I am focused on walking correctly (heel to toe, lifting feet directly up on stairs, getting all the way around on the stationary bike) I think that those numbers will come in time. Hoping that is true because I am really not interested in a new surgery to get it moving better. Hoping next week is as good as this one.

 

[Mutti3]

@Larryhg3
Sounds like you are doing great! Spring is almost here, and walking opportunities abound! Walking is a great exercise to build up strength, stretch those hamstrings, and relieve stress!

 

[sistersinhim]

Seems weird that the PT and doctor are all focused on flexion and extension number, I stopped stressing on those I am focused on walking correctly (heel to toe, lifting feet directly up on stairs, getting all the way around on the stationary bike) I think that those numbers will come in time. Hoping that is true because I am really not interested in a new surgery to get it moving better.

You are exactly right! What you can do is what is important, not what the numbers say. Unfortunately, in the US many OSs, and especially PTs, love concentrating on those numbers. That way they can justify your therapy to the insurance companies. The more people keep going to pt, the more money they make.

 

[Larryhg3]

Coming up on 6 weeks post surgery and feeling a little stalled on the ROM scale. As of Thursday my flexion was 95 and my extension remains at 7. I don’t have much swelling at all and only minor stiffness if I sit too long. I have been in Out Patient PT for 2 full weeks now. I do my stretches faithfully every day:
Heel slides 2 sets of 10 twice daily
Push knee to flat surface 10 as often as tolerated
Sit with heels on chair slightly higher than my hip 5 min twice daily
Seated heel slides 10 twice daily
Stretches on step 2 sets of 10 twice daily
Walk outside 20 min
Walk my house every 30 minutes
I also do physical therapy 3 x per week. Ice and elevate at least 3-4 times daily for 25 minutes per side of knee 50 minutes total. Starting to get frustrated when I go to PT and the ROM hasn’t improved. Every time it doesn’t the PT wants to “assist” which just plain hurts. On Thursday the PT said that my ROM was very poor to begin with and that it was going to be a very long tough road to get ROM back. Based on measurements of my non surgical knee I am already beyond where I started out but there is a lot of stretching and exercise to get where we want to be. I am working so hard and it doesn’t feel like it is working.
On a positive note I am pretty much done with pain meds. I still take Tylenol daily but the other pain meds aren’t necessary. I have noticed that my new knee, much like my old one likes to bark at the weather changes.

 

[Celle]

I think you're trying too hard, and doing too many exercises.
Try cutting them right back and just let your activities of daily living (ADLs)be your exercise.

After my last TKR, I did no formal exercises at all, just the ADLs. I only went to PT 3 times in total for the previous TKR. Both my knees are strong and reliable. They straighten fully and bend to over 125 degrees.

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.

A ROM of 95/7 is fine at 6 weeks.
There's no need to rush to get ROM, 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

 

[Larryhg3]

Coming up on 8 weeks and keep repeating to myself “everyone recovers differently”. The good news is that the weather is finally forecast to turn spring like this week. I was able to get outside and walk for 30 minutes both days this weekend. My knee feels so good after a walk. One thing I have noticed is that while walking I can “feel” a clicking inside the new one after a little bit. It is nothing compared to what it was pre surgery but it is there. I am still faithfully doing extension and flexion exercises. Still going to outpatient PT 3 days a week it drops down to 2 days starting next week. My PT is focused on strengthening my quads which were pathetic coming into this process and getting my extension better. Currently I am at 101/7 which I find terribly frustrating. There are people who are only 5 weeks out at PT with much better numbers. I hear their PT telling them it is because of all their hard work and leave so depressed because I am working so hard to get better. Just isn’t coming back for me.
Some positive things. I have ditched the cane I can walk comfortably without it. I was able to walk around the yard picking up sticks and winter **** for about 15 minutes yesterday. Coming up stairs step over step is pretty easy now going down still not there. I really want this to be successful but am slowly losing faith. And the future holds another new knee , maybe.

 

[mlwreader]

Oh @Larryhg3 please don't lose faith. Don't forget this recovery is a year long journey. I am no medical expert, but I wonder if maybe you might be doing too much? As I understand the bonesmart philosophy, over exercising causes swelling and discomfort, which in turn causes less ROM success. It doesn't mean you won't get the ROM eventually, because once all the swelling goes down it is there. That's what I understand at any rate. I am sure others will chime in. I was forced to stop PT quite early on because of problems with stitches opening up and various boring, but to me very upsetting, skin issues (which is talked about in GREAT DETAIL - haha - on my thread), and I achieved a good ROM and extension very early on despite no hard work in PT.

I still have some swelling in my knees, and from what I've read, at 7 months, which I am, I still have a ways to go to a complete recovery on this journey. Hang in there, keep coming back to bonesmart, and have faith that your journey is a work in progress and will take some more time before you get to the finish line. Please keep posting and let us know how you are doing.

 

[Celle]

One thing I have noticed is that while walking I can “feel” a clicking inside the new one after a little bit. It is nothing compared to what it was pre surgery but it is there. I am still faithfully doing extension and flexion exercises. Still going to outpatient PT 3 days a week it drops down to 2 days starting next week. My PT is focused on strengthening my quads which were pathetic coming into this process and getting my extension better. Currently I am at 101/7 which I find terribly frustrating. There are people who are only 5 weeks out at PT with much better numbers. I hear their PT telling them it is because of all their hard work and leave so depressed because I am working so hard to get better. Just isn’t coming back for me.

First, that clicking is normal.
It happens because you now have hard metal and plastic parts moving over one another, instead of the relatively softer bone and cartilage.
Clicking/clunking knee joint after surgery

Second, please stop comparing your knee with other people's knees. Your knee is on its own recovery schedule. No other knee was in exactly the same condition as yours before surgery and no other knee had the same amount of work done on it during surgery.

Third - get rid of the idea that working hard at your exercises will bring better results.
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.

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

A ROM of 101/7 at 8 weeks is OK. Your flexion is good and your extension isn't bad at all. It's not at all unusual for extension to take longer to achieve than flexion. You have all the time in the world to achieve full extension.

Quite honestly, I think you are working too hard and your knee would appreciate fewer exercise sessions, so it can relax, calm down and heal. The numbers aren't important. It's what you can do with your knee that matters.
BoneSmart philosophy for sensible post op therapy
TKR: work “smarter” and not “harder”
TKR recovery and an analogy to athletic training
TKRs and our fast food society

 

[Larryhg3]

I am sure you are right. Thank you for the input.

 

[Carpediem]

Hi, I'm also feeling the clicking as I walk. It's normal for TKRs. My first knee was the same way and it all disappeared in time with just a random awareness of the parts with certain movements. Hang in there with what you're doing, I think you'll find this next month to be much better in how you feel and how you move. Try not to overthink the clicking. Be kind to yourself, pace yourself for your knee alone, stay positive!

 

[SusieShoes]

Almost everyone gets to enjoy the clicking of their knee(s) at some point. Most of the time the clicking goes away later, though sometimes it sticks around. In either case, it doesn't mean anything is amiss.

Please don't compare knees. Yours is doing so well, I'm sure someone, somewhere, is being envious of your ROM. Your flexion is good for two months, just fine! And the extension will come with time. It takes time to stretch the big tendons and muscles behind the knee, so give your knee some time to accomplish this. It can take months to straighten a knee fully post-operatively.

PTs are fond of telling their patients that hard work got them a result. That doesn't explain, though, the people who have 0 extension right off after surgery, or those who do no PT and get wonderful flexion within weeks. People heal differently --faster, slower-- and each knee has its own timeline.

 

[Jockette]

PTs are fond of telling their patients that hard work got them a result. That doesn't explain, though, the people who have 0 extension right off after surgery, or those who do no PT and get wonderful flexion within weeks. People heal differently --faster, slower-- and each knee has its own timeline.

I love this! I’m going to copy it into my thread.

 

[Larryhg3]

Knocking on wood as I write this post.
I returned to work in the office this past Monday and it feels like I have turned a corner. The guys on my team remind me to get out of my chair and walk once an hour. If I come back in 5 minutes or less they make me go again. My superiors call it “doing my laps” and are very supportive.
At PT there is a PT Aide who is about to graduate and take his boards to be a PT who has made me his pet project. He reminds me as I begin each warm up that this is a marathon not a sprint. Reinforces that ROM will come but that it comes back when my knee is ready not when my PT, doctor or even I want it to. This week I broke through on Flexion jumping to 106. My extension is still lagging but my PT does gentle massage on my knee and hamstrings we measure again and it is at 4. Still not 0 but promising, she says “We are going to loosen those muscles if it kills me”. I am encouraged because it shows me that the ROM is in there just not ready to come out and play yet. I do all the exercises they ask of me at PT ( so long as there is no pain) but other than that all I am doing is walking 5-10 minutes every hour, going outdoors at lunch for a 30 min walk and coming home from work for another half hour walk outdoors.
The best thing is that there are occasional twinges of tightness and there is definitely swelling by the end of the work day, but I don’t have any pain. I lost track one lunch last week and walked for 45 minutes which caused it to ache but not enough to warrant medication
Finally get to come here and do something other than complain. Mentally and physically I am feeling good. Again knock on wood. I am sure I will still have bad days or even bad stretches but today is not one of them. Thank you all for the patience and support when it got really bad I came here and read your stories and found out I was not alone and that helped.

 

[kneeper]

5 minutes of walking once an hour is plenty to fight off stiffness. Unless you feel better walking more. You're doing great if you can walk 30 minutes at lunch. Don't forget to elevate--if not during the day, when you get home for sure. That will help with the end of day swelling.

 

[nuttybrunette]

Hi! Just reading thru your posts.... I am having left TKR on May 2. Yay.

But I had right TKR 10 years ago, when I was 40. All I heard was how quickly I’d bounce back because of my age. Didn’t happen. ROM was my nemesis. Stuck at 90 forever. At 5 months still at 90. But I was working out with PT that whole time, 3x/week for hours. Lots of pushing to get ROM. Still nothing.

Flash forward. Everyone is measuring both knees ROM just preparing for surgery. And my 10 year old knee is now at 120!! It was a looong marathon for me. This time I’m going to do less exercising and less worrying. Glad to hear yours is improving.

 

[Celle]

ROM was my nemesis. Stuck at 90 forever. At 5 months still at 90. But I was working out with PT that whole time, 3x/week for hours. Lots of pushing to get ROM. Still nothing. Flash forward. Everyone is measuring both knees ROM just preparing for surgery. And my 10 year old knee is now at 120!!

Thank you for posting this, @nuttybrunette . It's further confirmation that ROM can continue to increase for a long, long time. Very encouraging!

At PT there is a PT Aide who is about to graduate and take his boards to be a PT who has made me his pet project. He reminds me as I begin each warm up that this is a marathon not a sprint. Reinforces that ROM will come but that it comes back when my knee is ready not when my PT, doctor or even I want it to. This week I broke through on Flexion jumping to 106. My extension is still lagging but my PT does gentle massage on my knee and hamstrings we measure again and it is at 4. Still not 0 but promising, she says “We are going to loosen those muscles if it kills me”. I am encouraged because it shows me that the ROM is in there just not ready to come out and play yet.

@Larryhg3 - It sounds as if this PT Aide is going to be one of the good PTs. We need more of those.

Your extension will continue to improve. One way you can help it is by increasing the length of your strides when you're walking.

Now you're back at work, you could probably cut back on your PT sessions - working, plus getting there and back is additional exercise for your knee.

 

[Jockette]

The guys on my team remind me to get out of my chair and walk once an hour. If I come back in 5 minutes or less they make me go again.

That’s nice that they are supportive but only you decide how much is enough. Don’t let them push you to do more than you’re knee wants. If you overdo, you are the one who will go home in pain, not them.