TKR Moving forward.

[Cycle-Path]

Also, before I forget it, again, another new thing for me this week is that I can feel my patellar tendon relax during exercises. This is new for me and the tendon would stay engaged and not relax at all during exercises. I know it sounds strange. Here's an example - doing knee ups in parallel bars and alternating legs - my tkr knee would never relax like the non-tkr knee would. Usually when the knee is straight, supporting body weight, and the other is lifted and bending. Anyway, it is something that I've noticed the entire time and today it was relaxing just the my good leg.

 

[mendogal]

Re tendonitis: the risk is in the early days, not long term. If I recall correctly some folks had issues with the patellar "tendon" (technically a ligament but it's called a tendon).

That's why some of us more cautious folks wait several months to really challenge the joint under load. For me, having somewhat hypermobile joints makes me nicely flexible but does place me at a higher risk for joint injuries.

My regimen is Body by Science, a once weekly protocol in which each muscle group is placed under load based on time, not reps, working extremely slowly to the point of muscle exhaustion. When I tolerate two minutes, next time the weight increases 5 pounds (when I'm handling more weight, by 7.5 or 10 pounds). I love the meditative approach, focusing on structure and breathing to overcome wanting to Stop the Discomfort, but didn't feel ready to resume it until very far along in my post op journey. I'm delighted with the results.

Everyone assesses their capability and risk, so I'm just noting where you're at on the healing timeline and suggesting mindful decisions - which it sounds like you're doing.

 

[mendogal]

Also, before I forget it, again, another new thing for me this week is that I can feel my patellar tendon relax during exercises. This is new for me and the tendon would stay engaged and not relax at all during exercises. I know it sounds strange. Here's an example - doing knee ups in parallel bars and alternating legs - my tkr knee would never relax like the non-tkr knee would. Usually when the knee is straight, supporting body weight, and the other is lifted and bending. Anyway, it is something that I've noticed the entire time and today it was relaxing just the my good leg.

This is EXCELLENT!!!

 

[EalingGran]

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

I used to sometimes get a catch at the back of my new knee with a full stride/ full extension. My surgeon said that was the peroneal tendon catching slightly on the rim of the implant and it would settle. I was a bit anxious but I haven't noticed it for over 6 months.
As to other tendons and ligaments, my MCL ( medial collateral ligament) was overstretched by my very valgus knee pre-op. That took a long time to settle and be helped by stronger glutes. Which tendons and ligaments can cause problems post surgery depends on which are retained in your particular implant and also on the kind of damage/ stretching you had before. A really good physio/ pilates teacher/ trainer with an interest in anatomy and physiology can help you figure out what is happening in your body.
My pilates teacher helped me strengthen the medial glute ( vastus medialis) which massively helped my recovery and enabled me to do stairs normally again.

 

[Gibsco]

I was still in bed at one week with a brace on the operated knee due to a torn MCL the day of my surgery from walking up my steps too aggressively. You are doing very well. Just be patient.

 

[Cycle-Path]

@Gibsco
I hope that you're doing well now! My MCL is doing fine, fortunately. When I first started doing leg raises to side, when laying down on my side, my LCL sure felt weird. It's coming around now though and doesn't feel like it is loose/stretching when I do them.

 

[Gibsco]

MCL looks to be healed to the point it is no longer an issue. I wore the brace for 12 weeks and even did some of the PT while wearing it. I don't think about it anymore. Just dealing now with the stiffness and pain when bending.

 

[JWS]

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,

Strange different methods used by different PT. I am 13 weeks today and have never used any kinds of weights. I must be doing something right I am out stick building my wife a 12x16’ green house with 7’ walls and 10’ peak. I am climbing up and down ladders putting up rafters all by myself and most of the time do not even think about my knee. If I feel my knee start to protest I take a short break. I can do things now I was not able to do pre knee surgery. I asked about using weights for leg straightening and was told was not necessary for me anyway.

 

[Gibsco]

Wow!

 

[Cycle-Path]

@JWS

It's nice to hear that you are able to be that active at 13 weeks. I hope to be doing the same, if not more, when I get there in five more weeks. I've got to put siding on my new barn before winter.

 

[ProgressAtLast]

I have to agree with the comments on doing too much too soon. I had my first TKR in November 2022 and tried my hardest to follow the strict 3 times a day by 10 repetitions and I only ended up stressing myself out and feeling a failure.
I had my second TKR in December 2023 and decided I would do my own thing. So I made sure I raised and iced regularly sometimes more than I needed to but I just did little and often gentle stretches not forcing anything throughout the day. I would walk past the stairs on my way to the toilet and do some stretches on the stairs or I would stand up and lean against the wall and stretch a bit when I went to do a coffee but nothing regimented and definitely not 10 repetitions 3 times a day. I felt more in control and progressed a lot better than with the first TKR.

You will heal without doing anything strenuous.

I am now 8 months post surgery and walking 5 miles at a time without issue or pain when before surgery I was in a wheelchair.

Have faith it will all end well and make sure you don't cause yourself any damage following a too strenuous regime.

 

[Cycle-Path]

Today is the end of the second week of only doing PT once a week. I've just done stretches at home and normal activity. Before this I was doing PT 3x a week and pushing the home exercises.

My knee feels just fine other than what I would expect for post-op soreness. It feels like it moves easier (faster) and swelling is coming down even more. The heat in the knee is greatly reduced and the skin color is much more normal. Skin at and around the incision is way more loosened up from tissues underneath it. Not sure if you know what I mean, but before the skin felt tight as if glued in place. Yes, I have that lateral numb patch that is also slightly painful. The only change in ROM (135 & 2) is that extension seems to be a tiny bit better, but the joint itself feels like it moves more freely.

The biggest obvious change is that the muscles and tendons around the knee are relaxing. My tkr knee feels much more similar to the other knee. I can feel my patellar tendon constrict and relax like it should. Along with that it is getting kind of noisy. Clicking and clunking and I can feel the joint itself being a little mobile when rolling over in bed or shifting from the gas peddle to the brake (it twists/turns just a little bit) when relaxed. At first that scared me.

I'm glad to be moving out of the PT grind and into a more functional phase. I can't wait to get back to working out and chores are stacking up around the farm. My gait is fine unless the knee/leg is fatigued or swollen, but I do have to focus on it. I had a slight limp for so long that it seems to be a natural default.

Just two more PT sessions and I'll be on my own. That will put me at the 9 1/2 week mark. I'll have to figure out my own workouts at that point. As stated before I'll probably be giving my personal trainer a call. She's experienced with rehabilitation and will keep me from breaking myself.

Here's a couple of pictures from a few minutes ago. Today is 58 days post-op. The scar is not bad at all.

 

[mendogal]

What you describe about tendons and clicking and clunking and shifting all sounds very familiar!

 

[EalingGran]

Here's a couple of pictures from a few minutes ago. Today is 58 days post-op.

Your scar looks really great!
Sounds like you are doing really well. I wouldn't worry about the odd painless click.

 

[Layla]

Hello and Happy Weekend, Cycle-Path
You're healing nicely and making great progress! Your scar looks wonderful.

The clicking, clunking and popping sounds are common. It takes time for the soft tissue surrounding the implant to heal and settle in with the implant and begin working smoothly.

Here is an article on Clicking / Clunking, if interested -

Clicking/clunking knee joint after surgery

Revised March 9, 2021 by Jamie Many patients who undergo knee replacement surgery will describe noises that come from their replaced joint. People commonly mention a clicking or clunking coming from their knee replacement when they walk, and they often worry that something is wrong with their...

bonesmart.org

Enjoy the weekend!
@Cycle-Path

 

[Cycle-Path]

I'm a mess. I've been dwelling on knee extension again for the last few days. Still at a two or three finger gap between the floor and the back of my knee.

And my IT band still feels like a charlie horse where the tourniquet was. They take so darn long to heal...

Not being able to get my knee straight is why I have to focus on my gait so much. Glad I see PT today. I need to talk to them about this. If I can't get my knee straight I'm worried that it will have major employment consequences for me.

 

[EalingGran]

mess. I've been dwelling on knee extension again for the last few days. Still at a two or three finger gap between the floor and the back of my knee.

I can't honestly remember whether I could fully extend my knee at your stage. I know that full extension came later than flexion.
My surgeon really wasn't that bothered about ROM numbers and this preoccupation seems to be very variable between surgeons and countries.
I do remember that I found lying on my tummy on my bed with my lower leg hanging off for shortish periods did help to fully straighten. Also trying to walk with a full stride helped as well.
I wouldn't force anything or let anyone put weights on your leg.

 

[Cycle-Path]

The therapist said that she thinks my extension and gait will eventually come around. I'm off from my hip down due to the lack of extension. She mentioned the lack of engagement in my hip with stride and push off. Two degrees is all I lack. She verified that today.

Anyway, I sent a message to my OS to see what to do.

 

[mendogal]

2 degrees off 0 at two months isn't unusual.

Push off takes hamstrings and glutes. I agree with warming the hamstrings and then gently stretching them (as in @EalingGran advice re brief intervals of hanging off the bed).
The glutes, if weak, may need some reminders to activate during push off. I always find it helpful to place my fingertips on whatever muscle I'm trying to activate as it creates an immediate positive feedback loop.
Initiating the thought of the very beginning of getting up from a sofa or chair - without using quads or pushing your feet down, without actually rising! - can work core, pelvis, and glutes without stressing the knee joint.

 

[Cycle-Path]

Thank you @EalingGran & @mendogal

My therapists and OS are not at all worried about this. It is purely me because I feel "off" with every step. If I were a horse nobody would buy me and I'd be sent to auction. Lol. They don't care about the numbers at this point either. I'm far outside of their area of concern for ROM and today I was at 136° & 2°. The therapist only measured because she had to for the chart; she hasn't in a long time because she knows that I am concerned.

Hamstring is still tighter than my nonoperative leg as is my IT band and calf, so you may be right with the stretching. I have been working them every day with little progress. I do like laying on my belly with my feet over the edge. It feels good and provides gentle pressure in my knee that is easy to control.

Today the therapist recommended that I do some slightly faster than normal pace walking on a treadmill. I did it for 5mns at therapy today and it was no problem at all. Just my luck. I dislike "dreadmills".

Realistically I just need to relax and understand that whatever will be, will be. However, I am terrible at that and want to make sure that if things aren't optimal that I did the best I could.