TKR MAKO robotic TKR Surgery

[Maggie M]

I am a little over 6 months out of my TKR. I have done everything my Dr and PT wanted me to do but still don’t have the ROM I want but I believe it’s coming, maybe in another 6 months. It really does take a year to recover but you’ll be better at 6 months. I don’t want you to have unrealistic expectations of your recovery. I was very impatient at first and had to realize my knee was going to get better but maybe not on my timeline.

 

[namastebeach]

3.5 weeks post TKR OP, right knee, June 6th. Feels pretty good. Driving.

Swelling way down, scar healing white. Sleeping well, icing just once at night.

Only Tylenol arthritis for pain and Celebrex. Walking daily 1.4 miles. Doing PT as told daily, but not so motivated. Not really pushing myself at all. Less than 4 weeks, is this normal? Still at only 94 to 97.

Should I worry about scar tissue forming? When is PT essential? Thoughts? I know this site isn't pro PT and more about just healing longer. My surgeon says in 3 months I will see a big difference. True?

 

[mendogal]

Like I said, here 90 degrees at 6 weeks seems to be what surgeons want, and many of our members have done fine taking longer than that.

As you go about your daily life, increasing activity as tolerated, your range of motion will come back.
When I felt like I could do semi squats, I resumed getting things from lower cabinets and doing the cat litter; when I felt ready to do deeper squats, I resumed pruning and weeding the yard.

Good PT understands the cellular and soft tissue aspects of healing and collaborates with us, doing a variety of modalities to help us regain optimal function - it's a wonderful thing! Unfortunately not everyone has connected with good PT so we feel obligated to point out pitfalls (cookie cutter approach, overly focused on numbers rather than function) and abuses (pushing, pulling, cranking on joints, using weights to stretch).

There is scar tissue, which is part of normal healing, and there are adhesions, which really aren't as common as some PTs think, and take time to develop. Most orthos and PTs call them all scar tissue.

If you ever feel hard lumpy or ropy stuff under the skin that's some scar tissue that may well be temporary. Massage with the fingertips, circular plus lengthwise plus crosswise helps to soften and break it up, as does gently stretching the area. I experienced this on both knees. It never interfered with my range of motion.
With the first, left knee, it went away with me doing massage a few times a day.
On my second, right knee, it's still there despite many months of me and a PT doing deep massage and contributed to some lingering lateral quad discomfort and weakness that I needed to address with a Good PT.

 

[Nlh61]

I’m 6 weeks and my ROM is 120. PT is ending since I can do everything at home. I can walk through Costco, walk a mile on an indoor track (to hot in Arizona to step outside) and went back to water aerobics.

 

[namastebeach]

Thanks.
My in home PT ended today, week 3.5. I got to 100 ROM! Excited.

I still cant go down my stairs one step at a time normally. Doing the last stair was impossible, my right bad knee would not step down! How long before stairs are manageable? I have a 2 story house, so it's key for rehab, bedrooms and bath upstairs.

 

[mendogal]

My first knee, I could do stairs sequentially but awkwardly at 8 weeks.
My second knee, 6 weeks. Which is considered early. I think 8 - 12 weeks is a common window.

Going down stairs sequentially is particularly challenging: when the "good" foot goes down a step, and the new knee is left on the higher step, one issue is static strength and stability with the combo of knee and hip flexion.
The other issue is in movement, the smooth transfering of weight. With both key joints involved, it's actually quite a complex neuromuscular task involving proper sequential firing. Often it takes a while for traumatized nerves, muscles, and proprioceptors to talk to each other cogently and coordinate it!

 

[mendogal]

I’m 6 weeks and my ROM is 120. PT is ending since I can do everything at home. I can walk through Costco, walk a mile on an indoor track (to hot in Arizona to step outside) and went back to water aerobics.

That's lovely progress!

 

[kevinR]

Hello from across the lake in Seattle.

Who was your surgeon? I think I have heard of all of them.

1) I agree with all the comments about pain. You should not be screaming during PT. I never was asked to do anything painful.

2) Stairs are weird. With me, my leg just would not "fire" to step down. My PT and I did lots of things including practicing on low stairs. For a while I had to poke myself in the butt to remind my leg what muscles needed to work.

Happy healing.

Kevin

 

[invisiblenow]

I am 13 days out from my right TKR. Today I reached 0 extension and 107 flexion with my at home PT. My issue is the lingering tenderness and swelling which results in nighttime pain. I take one narco in the morning and a 5mg oxy at bedtime. I am hoping for the big turn of the corner soon so I get off pain meds and drive next week. This is a slow process and I know I am just getting started.

 

[mendogal]

I am 13 days out from my right TKR. Today I reached 0 extension and 107 flexion with my at home PT. My issue is the lingering tenderness and swelling which results in nighttime pain. I take one narco in the morning and a 5mg oxy at bedtime. I am hoping for the big turn of the corner soon so I get off pain meds and drive next week. This is a slow process and I know I am just getting started.

Would you like to start your own recovery thread?
It will make it much easier for you to track progress and for folks to reply to you directly!

It's important to not only be off pain meds but to have the strength and ability to slam on the brakes if you need to. Most of us don't drive at 3 weeks.

 

[invisiblenow]

Thanks! I am new to forums and I am not quite sure how to navigate things. I do a lot of reading the posts though. I find them very helpful.

 

[Layla]

Hello and Welcome! I'd be happy to start a thread for you so you're able to tell is a bit about your recovery so far and we can share some recovery guidelines. Will you please join us?
@invisiblenow

 

[namastebeach]

Thanks kevin and mendogal. I have stopped screaming and can now breathe into the tough flexion to get my knee down well. At 3.5 weeks, I have to practice more on stairs down, I can do stairs up normally, but still not easy. Today I got to 100 ROM with PT, excited.

This seems to be a long ardous process, love my long walks and icing!

 

[MSPS]

I sorta think everyone here knows how you feel and I have been very aggressively told by my brother in law and others with TKA I'm a wimp in so many words. Ok, let's look...b-in-l is a Tough Mudder...explanation enough. I'm a 70 year old woman who regularly did 4 mile walks and kayaked *gettingis absolutely horrified at being hampered BUT without this website I was in such despair I felt almost suicidal. The pain and lack of motion were so overwhelming, wished I still had the bum knee...still issues BUT!!!! IM BARELY 5 MONTHS OUT. only if you hear these people will you get to where YOU are in control. You can do every exercise you need at home, on your schedule ...I'm still not up THEIR numbers but think...woah...do I NEED to bend my knee backward or tuck my heel 2 feet behind me...to do what? For what? to move on? because its a goal???? if I can walk without pain again (which I expect!) I'll be beyond where I was...no more could I ask. Glad you're here...irs the right place!

 

[Layla]

My surgeon is correct that PT, per exercises for TKR are standard and everyone should do them daily 1 to 5 times a day.

This is a matter of opinion, not fact. Many do well without PT and there is evidence of that, here, on this forum.
Certainly this is personal choice. If you find aggressive therapy, to the point of screaming, is benefitting you, continue engaging. However, I believe you're in the minority in that regard, most will not subject themselves to extreme pain. A multitude have recovered fully without pushing through pain, but allowing their body to heal from the controlled trauma of a major surgery coupled with a gentle approach to exercise and any PT they engage in.

 

[Jamie]

@namastebeach …. Please understand that BoneSmart is not against physical therapy. In fact, we are a great proponent of having the guidance of a good therapist to help you reach whatever your goals are for recovery. We stress the importance of gentle movement regularly during the day that bends and stretches your knee and challenges it to the point of mild discomfort. This is the approach we have found works best for most people. All patients are encouraged to walk and do gentle bends and stretches from the very beginning of recovery. We advise that they listen to their body and gradually increase exercise and activity as they can without incurring pain or swelling so that inflammation is kept to a minimum.

I understand that you love your surgeon and want to please her. But recovery is very individual and what works well for one doesn’t work for all patients. The best approach is to listen to the cues your body sends you and react accordingly to increase or decrease your activity and exercise as you go along. The path is not a straight one and there most likely will be some ups and downs along the way. The thing we do tell patients (and this comes from working with tens of thousands of joint replacement patients) is that severe pain in therapy is usually not a good idea. Use aggressive therapy if you feel that works for you, but when the pain passes the discomfort stage, you are doing damage to tender, healing tissues that will result in keeping your knee inflamed. This is especially true in the early weeks of recovery. Your body only has a specific amount of energy to give and if it must spend the energy fighting inflammation (that takes priority), there is less actual healing going on.

There was a time probably 10 years ago or so where a majority of the surgeons we work with did recommend aggressive therapy at the beginning of recovery. But things change and research studies are done. Now all our surgeons agree with the recovery approach BoneSmart has had for over 15 years and they want their patients to allow for tissue healing for several weeks before going beyond gentle bends and stretches.

I’m not sure where you got the idea that 25% of knee replacement patients have “bent” knees, limp, or adhesions (different from healing scar tissue). That is not the case at all and studies do not support a statement like that. I don’t think you’re at risk for any of these problems, so please try and relax and let your body heal in its own time. Unfortunately there is nothing you can “do” to make healing go faster. Patience is your best friend. All the best to you in the coming months.

 

[namastebeach]

I dont know why you folks think my PT is radical anymore , its not . Its very standard and everyone is advised to do daily PT if they wish to be very active in future , many dont want to be active , and thats ok .

I had pain the first time I did PT , it went away after regular daily PT , more frequently .

Also its now almost week 4 , so every day gets easier . I do walk a lot and stay active, dont sit much as it locks up.
My recovery is very early, and my surgeon says I should be great in 3 months , lets see.
I know many pals who did great in 2 months to 3 months .
this surgery is to get back to being active with no pain .
My weight , prior activity , and individual leg ,all count towards results per my surgeon . PT is essential to success, many do it on some level forever , its just basic exercise , like yoga .
I cant wait to do stairs down on week 5. Nothing I am doing is aggressive , just relaxed and normal. I hope you read most of my recent emails .
Love to learn more about others with fast healing and GOOD results with TKR surgery, rt knee .
Maybe some got well in 3 months . that's awesome !

 

[benne68]

Love to learn more about others with fast healing and GOOD results with TKR surgery,

I'd encourage you to read more of our stories.

I've had both knees replaced and have had excellent outcomes. I am back to an active life -- hiking, biking and boating without pain or worry. I just came home from a two-week safari in Kruger National Park in South Africa (six month post-2nd TKR) during which I did lots of hiking and climbing in and out of safari vehicles. I couldn't have asked for more from my knees.

On the advice of my surgeon (who is with Hospital for Special Surgery, the world leader in orthopedics),
I took things slowly the first month, allowing the bones and soft tissue to heal properly before going to physical therapy. Once I started, I progressed quickly because my body was ready. My ROM came back quickly. I had a great therapist who is specifically trained in helping patients recover from joint replacement and who never once made me scream in pain.

We are all different and only you can decide how you want to manage your recovery. BoneSmart is here to help.

 

[mendogal]

I too have had excellent recoveries and results on both knees done in 2023.

I summarized my second knee's milestones in a one year postop post here.

 

[namastebeach]

sounds great !! love good stories and faster recoveries as so many are well by 3 to 6 months .

Mine is just the right knee . I still feel stiff and tired after driving , less than 4 weeks post op .
My ROM is now 100 , so thats ok.
Safaris are sitting in jeeps for a long time , 6 months out thats a good activity , my safar wasnt really active , no 6 mile hikes , masa marai , kenya.
my surgeon includes PT the day of my outpatient TKR OP ( standard these days ) and most of the PT is simple , except the knee drag back moves or coming down stairs .I start real out patient PT past 4 weeks , I am sure that will help . This is a dull, slow period , 3 months feels so far! thanks all