TKR Leg Extension Concerns After 2 Months

[mendogal]

There's a huge range of "normal" for how long our members seem to need the stronger pain meds. For a lucky few it's a matter of days (I can't even imagine!).
For many of us it seems to be somewhere between three weeks and two months, doing slow decreases in dosage and increasing time between doses, with an "as needed" dose now and then after that.

 

[Charlierun]

How much time does everyone spend just lying down and resting after total knee replacement ? I ice 5-6 times a day, sit up for meals, do physio exercises for hour in am and 30 minutes in pm. I go for brief walk outside for 15- 20 minutes once a day. That leaves a lot of time to lounge on couch, . My left knee replacement was 2 weeks ago , the right was a month ago. Is that too much time laying down?

 

[mendogal]

At two weeks and at a month I didn't do an hour of exercise (heck, NOW except for tai chi, I don't do an hour of exercise unless it's a really long walk!)

My ortho wanted me up walking every hour, so besides meals and hygiene I was up that often from day one.

By three weeks I was up to assemble my breafast and lunch, folding laundry, watering my outdoor succulents with MDH fetching the full watering can. I considered things like that my exercise regimen (plus seated heel slides and quad sets) , gradually adding in more challenging chores and longer walks.

 

[EalingGran]

Agree with @mendogal that shorter bursts of exercise more often are better than an hour at a time once a day. It is better both for not aggravating things but also keeping the circulation going and avoiding clot risks. Getting back gently to normal activity is good

 

[FleuveStone]

I do welcome any input as to what would be a safe way to have a pillow there without a bend.

A slight bend is fine and much more comfortable. Many of our members like the Lounge Doctor pillow for safe elevating:

bonesmart

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I have the following elevating pillow from Amazon:

I have something similar from amazon.ca to which I add a pillow or two for more height, but didn't get it for a couple of weeks post-surgery (because I hadn't found bonesmart yet!). I wish I'd known that it was okay to have a slight bend in the knee because, if anything, I've probably got hyperextension of the knee, which no one has ever mentioned to me. My extension has been pretty much zero from Day 1 so I definitely shouldn't have had to worry about it. And it's painful where the patella seems to push into the thigh if I'm not mindful when elevating.

Flexion on the other hand is a different story! Glad I know not to push it now, thanks, Bonesmart!

 

[Charlierun]

I sent a picture of the wedge with the bend to my Physio who works very closely with my surgeon, and it was a definite no to anything with a bend. I’m not comfortable going against my doctor’s protocol so I will adhere to using the wedge that is straight. Interesting to note how doctors do differ on what they prefer. I guess as long as we achieve the final goal which is a successful knee replacement without complications.
I got my hands on a stationary bike that can be dialled down to zero resistance and I biked backwards on it for five minutes today. It’s been two weeks since my left knee and a month since my right knee was done.
I must say my knee was quite uncomfortable after the bike, but I didn’t get a lot of swelling. How are most people finding the stationary bike for rehab?

 

[Layla]

That's okay...you need to do what you're comfortable with.
Consider trying the stationary bike for less time, then slowly add time.
Happy One Month Anniversary, Righty! Enjoy the week.
@Charlierun

 

[Charlierun]

Hi, My right leg is now one month since the replacement and my left is just a little over two weeks. I saw my sports physician today and he recommended Reparel knee sleeves to help with the pain of sleeping at night with straight legs. Has anyone ever tried these? They definitely will be more comfortable than the Ted stockings we had to wear for two weeks post knee replacement. I must admit I didn’t keep my Ted stockings on as long for my second replacement.
My sports physician also said my left knee needs more bend before I can do the bike.
Also, does anyone feel the ice therapy makes the feeling of stiffness in the knee more pronounced?

 

[Jockette]

I did feel much stiffer after icing my leg.

Hopefully your medical team is not pressuring you about your ROM. It’s early days for you, and having both done so close together means your body is trying really hard to heal. Try not to rush them. All will be well in time.

 

[JWS]

I am eight weeks today and I am about 127 flex and about 1 to 2 straight. I keep stretching and have a couple more PT visits before insurance cuts me off. I will keep doing home exercises but I if never get 0 straight I am happy where I am at. After all before replacement my straight was at 7 to 8. If you stop and look at 1 to 3 degrees that is very small angle.

 

[mendogal]

Re the knee flexion and the bike: It takes some of us quite a while to be able to complete a revolution. There's no rush!

My L knee was able to quite early.

My R knee bend while walking or sitting was functional early on. Yet when the bend had to be combined with hip flexion - as in completing a revolution on the bike or getting into the driver's seat with my new R knee - my knee joint just couldn't handle it. It took 9 weeks before I could manage a couple of slow, painful revolutions.

It was another few weeks before I could comfortably do ten minutes at a time.

We all improve differently and at our bodies own pace.

 

[Charlierun]

Hi, I am almost 6 weeks out from my right knee replacement and will be 4 weeks for my left knee in 4 days. Seems like my right knee was much less stiff at this time. I can definitely get to 90 -100 on my left knee and 100-110 on my right knee. Is it too soon to worry about the fact that my left knee doesn’t bend more than it currently does?

 

[Layla]

Do not worry. You're doing just fine. You're only 24 days post op with your left knee and slowly but surely over time, you'll get to where you want to be. Remember that no two recoveries are alike, even with the same person, which you can now attest to.

Here are a couple accounts of other members progress

Campervan’s ROM history
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

Bertschb’s ROM history
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

Hang in there it's still early days. Lots of time for progress. A great week to you!
@Charlierun

 

[Campervan]

Campervan’s ROM history

Well, I'm glad my first TKR recovery progress is still helping others. I'm now a hippie as of 6 weeks ago and recovering really well so I thought I'd pop over to knee recovery and see whats happening here. RTKR is now 12 years old and LTKR 9.

I can attest that no two recoveries are alike - my RTKR took months and I still used one crutch at 4 months but my LTKR I was walking without crutches at 2 weeks and moved house at 3 months to the other end of New Zealand.

 

[Layla]

Happy One Month Anniversary, Lefty!
I hope you have a wonderful week!
@Charlierun

 

[Charlierun]

Hi, It is four weeks for my left knee replacement and I was able to cycle forward on a small desk type cycle today for five minutes. I continue to find it frustrating that my knees become so stiff after icing and the band feeing intensifies! I am not noticeably swollen anymore. It is 6 weeks since my right replacement was done. I was able to 2.5 miles today relatively comfortable with hiking poles. When will this tight band feeling go away? Would a medication like Flexeril at night help this? Arlene

 

[Layla]

Hi Arlene, Great news on the full rotation on the under desk pedal exerciser! Remember that it is still early days and you'll enjoy further progress in the months to come on this often one year recovery.

Your leg endured major trauma, in a very small area, albeit controlled. Your muscles, tendons, ligaments and other soft tissue is going to cause you discomfort and pain for a while yet.

The tight band sensation, it is caused by scar tissue, but not the adhesions type of scar tissue.
During surgery your OS undercuts the skin and superficial structures from the center, to each side of the knee, to obtain access all round the bones. While healing, those flaps re-attach themselves to the main body of the leg, creating a thin layer of scar tissue across the front and sides of the knee. Scar tissue isn't as flexible as normal tissue so it feels like a clamp across the knee if there is any swelling and later during normal activity.

In time it gradually reduces in size and thickness until it reaches a point where it's not substantial enough to cause this sensation, same goes for the incisional scar in the skin. This can take several months to dissipate completely and often excess walking or standing can make it worse. This differs from person to person.

I hope you have a good rest of the week! Thanks for the update.
@Charlierun

 

[EalingGran]

I was able to 2.5 miles today relatively comfortable with hiking poles. When will this tight band feeling go away? Would a medication like Flexeril at night help this?

I think it sounds as though you are doing really well. I found walking the best exercise and the hiking poles sound a good idea.
I know it is frustrating but the tight band feeling is absolutely normal.
It was explained to me as due to the knee being a small joint and even tiny amounts of fluid causing compression and tightness. I found that although it lasted several months- it gradually faded. I found it only came on later in the day and cleared with rest/ elevation.
I can't remember exactly when it disappeared totally but it was probably at least 7- 8 months.
Hang in there- you are doing great!

 

[Charlierun]

I find my flexion decreases a lot by the end of the day. I am trying not to worry about it as my flexion on right knee is 120 ( 8 weeks post tkr) and left knee is 100( 6 weeks post tkr) By the end of the day it feels like both knees above the kneecap are a lot stiffer. I know it has been explained to me that this is normal but I worry that I might be building up a lot of scar tissue.
Does anyone have any tips or suggestions on how to prevent the stiffness at the end of the day?

 

[mendogal]

Stiffness that builds during the day with loss of flexion is more often associated with increased swelling as the day goes on than it is with scar tissue. It is a nearly universal experience as near as I can tell from our members!

The swelling need not be visible to affect range of motion and often it results from an imbalance between activity (too much) and elevation + icing (too little; at eight weeks we still benefit from 45 minutes at a time of icing with toes above nose!)

As long as your flexion isn't steadily reducing, or staying stuck at a plateau for a while for no apparent reason, you're ok.