TKR Moving forward.

[Cycle-Path]

Six week update from my post-op visit this morning:

- The doctor was very happy with my progress. When I voiced my concerns with extension they said I was nuts and that both flex/ext are excellent. They actually said that I am far ahead most and people struggle to get where I am at when they are 100٪ healed. Guess I'll stop complaining about it, but I am going to keep working towards pre-op ROM and get as close to I can towards "normal".
- They said it's okay for me to get therapeutic massages, to wear compression braces, and to start driving again.
- X-ray attached for fun. Looked fine.
- I asked about continued swelling and they informed me that it was normal and to be expected for a year. Although they said the associated discomfort with it will start to decline and that it should be painless swelling around the three month mark.
- They told me that PT will start shifting more toward strengthening, but to be sure to pay attention to what my body says while doing it.
- Discontinue daily aspirin and compression socks. Honestly I haven't worn the socks for a couple weeks.

That's about all I can think of right now. Have a great day!

 

[benne68]

Great update, @Cycle-Path! Sounds like you have a wonderful surgical team who really understand the length of this recovery. Hope you were reassured by what you learned.

 

[mendogal]

 

[Cycle-Path]

I've got a little something to add about my visit to the doc earlier now that I have a few more minutes. It's kinda funny too. So, as I was complaining about my extension being around 3°, the doc said, "hop up on the table and show me". I did and when I extended my knee out it hesitated for a second or two right where it always does, but then, then it decided to just basically go ahead and flatten out on the table. It normally stops about an inch over the floor/platform and stays there, but no, not this time. It just relaxed right out after stopping like something in my knee decided it was finally okay. Embarrassing. Lol.

I had PT this afternoon and it went well. They added one new exercise and that is a forward step down loading the new knee. They also told me that my military retiree insurance reduced me to only four more sessions. That's alright, I think I'll be fine. Because of that I'll only be going weekly with home exercises.

Since I can drive I took myself for a haircut. Thwn I drove by my favorite BBQ joint and grabbed a rack of ribs that I've been craving. Lastly, I stopped by work to see my buddies for a few minutes. I though that I took it easy, but I now see that my watch gave me a thumbs up for 2,000 steps today along with a new recent record. Lol. Knee feels fine though, so hopefully tomorrow it's still doing fine.

 

[benne68]

as I was complaining about my extension being around 3°, the doc said, "hop up on the table and show me". I did and when I extended my knee out it hesitated for a second or two right where it always does, but then, then it decided to just basically go ahead and flatten out on the table.

Isn't that always the way things go? It happens to me whenever I call the tech guy for help with my computer -- he says "show me the problem" and it works fine for him!

Glad to read that you are driving again. Another recovery milestone!

 

[Layla]

It normally stops about an inch over the floor/platform and stays there, but no, not this time. It just relaxed right out after stopping like something in my knee decided it was finally okay. Embarrassing. Lol.

A good embarrassing though.
Yay for progress Happy Friday!

 

[WFD]

It just relaxed right out after stopping like something in my knee decided it was finally okay.

More likely, your hamstring muscles relaxed. Have you tried really easy hamstring stretches? Done only to the slightest level of tension for a minute or more, with relaxed breathing, might teach your hamstrings to relax completely.

 

[Cycle-Path]

@WFD
I agree that it is likely my hamstring. A normal morning for me, before ruining my knee in early May, includes a lot of stretching. I've had an L5-S1 injury and keeping my legs and hip flexors loose really helps to keep me comfortable. Since having my tkr this has not been possible and the surgery itself aggravated my hamstring.

I've been doing what I can as far as stretching, but I may be overdoing it. I'll take your recommendation to give it a go gently and hold it longer.

Thanks.

 

[Cycle-Path]

Almost seven weeks now. Pt is now once a week and going well. They're picking up the pace a little.

New at PT this week:
- using 3lb ankle weights For all leg exercises.
- added stepping down steps to stepping up from the front and side.
- started doing leg presses with a whopping 40lbs for double leg & 20lbs single leg.

All together PT takes about an hour. I did it yesterday and feel pretty good today. Just a little sore, but not enough to change my gait. I'll be doing it on my own three or four times a week.

I've been struggling to sleep well for the last week and it's getting old. I think I might start hitting the gym a little to wear myself out doing some upper body work. I also need to keep working my hamstring. It is pretty tight and that is probably causing my extension challenge. Not that it is really bad. I can usually get it as straight as it will go and then use my pinky and ring fingers to fill the gap behind my knee between the floor. The hamstring is more noticeable now that I can get down on the floor and stretch closer to how I would have pre-op.

Last thing to note is that the knee is still swollen. Mainly locally to the joint and seems to be getting better daily, but I have not yet seen what my knee will look like.

I need patience...

 

[Layla]

I've been struggling to sleep well for the last week and it's getting old.

Hi Cycle-Path...Happy Thursday on this gateway to the weekend.

A few tips you may consider, if you haven't already -

Magnesium supports the following:
Bone health
Healthy blood sugar
Cardiovascular health
Muscle relaxation and nerves
Promotes healthy sleep (falling asleep and staying asleep)

An article on Magnesium -
https://bonesmart.org/forum/threads/magnesium-is-a-star.20301/

Pillows certainly helped me get comfortable in bed, making it easier to drift off.
I think it's worth making up the bed with your most comfortable bedding / blankets along with a few extra bed pillows of different degrees of firmness. Try to block out the light if it's daytime. Minimize noise unless you feel listening to calming relaxation music, a fan, or white noise may help lull you to sleep. Make sure the room temperature is not too hot or too cold. Try to disconnect from the devices at least an hour before the targeted nap or bed time, so it's easier to wind down. Limit caffeine throughout the day and consider natural sleep aids such as Valerian, Chamomile or, Magnesium, my personal favorite, which can assist in muscle relaxation and nerves and promote healthy sleep (falling asleep and staying asleep)

Most large grocers carry a variety of teas such as Celestial Seasonings - Sleepytime Herb Tea,
Yogi Teas, Bedtime, Bigelow Cozy Chamomile, all of which may help you relax...at least worth a try.

 

[Layla]

Last thing to note is that the knee is still swollen. Mainly locally to the joint and seems to be getting better daily, but I have not yet seen what my knee will look like.

If you notice this is in relation to your PT or any workouts you may be engaging in, you might want to try dialing back frequency and duration and see if you notice a difference. You just may...and if so, s-l-o-w-l-y build back.
Certainly not too late to ice and elevate for swelling, if you've stopped.

All the best as you continue the journey! Thanks for sharing your recovery here.

 

[Cycle-Path]

Coming up on my eight week mark.

- I've been reduced to PT once a week since I was doing well with flexion and strength, but was suppossed to be doing it at home three or four times weekly. Since I've been sore I stuck with the basics at home this past week and skipped the more difficult strength exercises. Guess what? My knee feels much better today and the reduction in swelling is noticeable. I have also noticed a slight increase in extension.

- Had my PT session for this week today and I did our normal routine. My swelling stayed down and the knee feels pretty good, just tired/weak. I'll see what tomorrow brings and adjust accordingly.

- I'm averaging over one mile a day in total steps per my Garmin.

- Still struggling to get my leg muscles stretched out to pre-op equivalent. I'm.also noticing some hip, groin, and lower back fatigue by the end of the day. Leads me to believe that there are adjustments happening as I get moving again. Makes sense given that my knee has hurt for 15 years and I had a gait change. Really focusing on proper gait and follow through.

- I have been struggling with frustrations related to slow progress in recovery. Yes, I knew it would take a while, but I certainly did not expect it to be so mind twistingly dispiriting.

- The pain is mostly gone at this point. However, it is still tight and painful at night. Sometimes if I get pain during the day I would describe it as similar to a toothache that is manageable with tylenol.

Enough for now. Have a great week all!

 

[EalingGran]

using 3lb ankle weights For all leg exercises.
- added stepping down steps to stepping up from the front and side.
- started doing leg presses with a whopping 40lbs for double leg & 20lbs single leg.

That seems a lot to me for your stage.
I am not surprised you swell.
I didn't use weights until about 5 months.
I keep up my regime at 18 months and do a glute strengthening regime most days with either ankle weights or a resistance band.
I think a lot of people do too much early on and then don't persist with regular exercises later. I read a paper that measured leg muscle strength post TKR. It found that while the muscles improved over a year- there was still significant weakness at 1-2 years compared to the non operated side. This could be reversed with regular long term exercise. I have treated it as a marathon not a sprint event and my leg is now stronger than it has been for years.

 

[mendogal]

I agree with @EalingGran !
Way too early for using ankle weights - your muscles are well along in healing, but tendons, ligaments, and bones are NOT. We have had members develop acute tendinitis from this.

I waited longer than she did to use weights, focusing instead on distance walking, hills, yardwork to build strength and flexibility.

When my newer knee was 10 months old I resumed serious strength training, using machines to do quad extensions, hamstring curls, and adjusting the abductor machine to target my glutes. I'm doing a once a week work them to exhaustion plus eating protein at every meal and seeing great results.

 

[almostready?]

Hi Cycle-Path,

I’m about one week behind you. It sounds like we are similar places, and I think we are the same age. My ankle weights (2-3 lbs) feel totally fine with some exercises and not for others, so I just use them on the ones that feel good. I am trying to do 5-10 min on bike with no resistance. My PT gave me a goal of getting to 125 from 120 and from 2 to 0 for ext/flex over two weeks which I think is a reasonable things to gently aim for. Just wanted to say hello and share that. Have a good week!

 

[Jockette]

My PT gave me a goal of getting to 125 from 120 and from 2 to 0 for ext/flex over two weeks

Your body is going to heal and improve on its own timeframe. Goal ROM numbers and timeframes are not a good idea, your knee doesn’t understand that. If you don’t accomplish such a goal it messes with the mind and you’re frustrated. Slow and steady, and acceptance of your body’s healing, will get you through this recovery.

 

[Cycle-Path]

I’m about one week behind you. It sounds like we are similar places, and I think we are the same age.

Hello! The ankle weights aren't really bothering me either, but the steps/stairs certainly did at first. Yesterday I used 4lb weights during the leg raises and other exercises. I do not like the weights for heel to butt and will not use them for that. I keep getting some kind of clicking/rolling with that motion even when doing them on my belly.

Stepping up forward and the side isn't an issue either, but I really focus and control stepping down. I'm also doing reduced reps with those. I only do 10 instead of 20 like the front/side steps.

Fortunately biking has never been an issue for me. I could do full revolutions week one and do five minute warms ups at every session with very little resistance. My flexion came around rather quickly and without issue. I would simply bend it doing heal slides until I felt it get tight, then straighten and repeat. I never pushed into pain. So be careful chasing numbers.

Extension is my issue. I seem to be stalled at about 2°. I can on some days get it slightly better, but haven't had it straight yet. The best I can get it when straight out on the floor is to get two fingers between the back of my knee and floor. I usually start while being able to get three fingers in the gap.

Thanks for commenting.

 

[Jockette]

Extension is my issue. I seem to be stalled at about 2°.

2 degrees is practically straight and is very good so early in your recovery. It will get better with time.

 

[Cycle-Path]

@EalingGran @mendogal

You two may very well be right regarding weights. I just don't know, so I'm trying to play it by feel. Prior to surgery I was a pretty frequent visitor to the gym and moved significantly more weight than they are asking me to use right now. I am a big fan of high-intensity interval training (HIIT). If not for that I would not even think of doing these exercises right now and DO NOT recommend others do them without serious consideration to their prior physical condition.

I was working out and running up to one month before surgery when the lateral cartilage/meniscus in my knee fell apart causing the need for my procedure. Medially I was already bone on bone and my ACL was damaged - about 50% remaining. I know this from an arthroscopic procedure in 2017 to clean up the cartilage medially/patellar and to trim the damaged ACL and some meniscus.

I did get a bit nervous yesterday at PT when they asked me to do leg extensions on the machine. I had to stop doing those earlier this year due to severe knee pain in the knee that was just replaced. Anyway, I decided to try them, but reduced the weight to 30lbs knowing that the cause of my previous pain was from my destroyed patellar compartment that was removed. Before surgery I had to do reverse lunges and dumbell squats instead of leg extensions.

I only have two more PT sessions to go. My plan is to do what they recommend, unless ridiculous, in order to learn some limits. I'll need to know them in a couple weeks when I'm on my own. During the week after PT I'll do more stretching and ADL type of exercises. When PT is over is when I'll be at serious risk; because I am really bad when unsupervised.

I'll probably hire a trainer to help guide me. I did the same 1 1/2 years ago when I was released from therapy after getting my shoulder fixed (rotator cuff, labrum, and bicep reattached in my pectoral tendon (Aug 23, 2022)). The shoulder procedure required a great deal of care after PT due to the biceps tendon repair. Which leads me to a question.

What tendon and ligament trauma is associated with a tkr? I seriously don't know, so I am failing to understand the risks with them regarding this procedure.

 

[almostready?]

I’m curious too - the PT I have said that sometimes that crunching feeling in the back of the knee is the peroneal tendon trying to figure out how to be with the new hardware.