TKR One year later and all is well

[Josephine]

It has been 4 months . . . shouldn't I be able to go downstairs normally by now?

Not at all! I took me 5 months before I could do stairs normally with my first knee. Everybody varies. Don't worry. One day you'll find it just happens!

And I waddle when I walk - I guess that's akin to a limp. Is this what is making my glutes and my lower back sore?

It certainly would be.

Can anyone advise if the ROM I had pre-surgery will have a bearing on the ROM I can expect by the time a year has passed? Pre-surgery ROM was 71 degrees.

Oh absolutely! I BIG bearing. This will account for your other perceived sluggardness in progress.

 

[Jennszoo]

I am amazed that OS and PTs don't take pre-op RoM into account more. If you were only bending 71°, you'r musckes and ligaments were a length to accommodate that bend. To bend more, you'll have yo stretch those tissues out, slowly and gradually.

 

[Celle]

Some people say that pre-surgery ROM has a bearing on the ROM you achieve after surgery, but that's not necessarily so. It does mean, though, that it will probably take you longer to achieve a greater ROM.

Just to help reassure you let me post a comment by one of our members who had a slow gain of ROM (Thank you, @Campervan ):
As you can see, her flexion continued to improve for a long time.
"I had a slow recovery. Here's my flex measurements at various points:
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
125 - 1 yr 8 months"

It will take time for your ROM to increase, not only because of the swelling, but also because you will have to gently stretch the muscles and tendons that had shortened while your pre-op ROM was poor. You can't hurry that process without doing damage.

 

[Minstrel]

Nearing 6 months post-op - an update

After spending most of the summer away from home and thus, unconnected electronically, I have been reading on this forum for some insights into my progress based on the experience of others (in a general way). Out of curiosity, I was measured recently and I have gained all of 8 degrees of ROM since my 3 month check-up at the beginning of June (extension is now 2, previously 6; flexion is 100, previously 96; total ROM is 98 from 71 degrees pre-op). Way back when as I was approaching the 6 week post-op mark, I was told the expectation was 0 degrees extension and 100 degrees flexion, so I have finally achieved that benchmark . . . albeit 4 and a half months late!

I am still learning not to allow the progress of others with their ROMs far greater than mine, much earlier in their recoveries, to get me down. I now understand that, for me, flexion may never get much past where it is now. However, if I was skiing, and cycling and walking before surgery, then, as my surgeon has said, I should be able to ski, cycle, walk and more since my ROM is so much better than it was. (+27 degrees overall). For me, function is more important than numbers.

Two days ago, I returned to work - a job that requires a lot of physical exertion. That first day saw me getting in and out of my car dozens of times (raising and lowering myself on my bent operated leg). There was also a couple of kilometres of walking. The total time I put in for about the same amount of work pre-surgery was comparable.

In my eagerness to return to work, I'm pretty sure I overdid it. There is a new and different sensation of stiffness in my knee joint - seemingly beneath my knee cap. And my quadriceps (both legs) are sore - the near absence of physical activity these past several months has resulted in atrophy like I have never experienced before. Muscle tone has gone!

My recovery has certainly not unfolded as I expected. I really thought I would be so much more agile, so much more able to go up and down stairs, so much more able to walk without tiring. I feel like I'm in one of those stages of grief - the one known as "acceptance". I had no choice but to go through this experience sooner or later since my knee was so badly worn, but I was expecting that things would be far better by now.

 

[Pumpkin]

Minstrel,
Welcome back!

Sounds like you are finally where you expected to be much earlier.
Some of us are on the slow train to recovery, but we get there. You still have a good 6 months of healing ahead of you, be sure you take care of your knee when you are at home.
Rest, Ice, Elevate, and Medicate as needed, follow the directions on the bottle.

Most of us are fatigued when we return to work, take care of your knee, as you get used to your schedule you will have more energy.

 

[Pk4tmjsd]

Hi Minstrel:

I am only a recovering TKR patient.........right on March 28; left on June 6 - both this year. I have no medical background.

Are you doing "too much?" Soft tissues inflamed? Have heel slides helped to get some ROM? I have found Bone Smart to be helpful - yes, we are all different, but the prevailing theme seems to be accurate. When I have pushed my knees, they became upset and didn't wish to play nice; when I have tried to be patient and calm and 'let' them heal, they will at least tolerate my wishes. Five weeks post-op is not a long time. This recovery road - I am finding - is uncharted for each of us and LONG.............

As for walking, I thought that was what we were supposed to be doing......from the start, hospital and in home and out patient PT wanted to "see me walk." I understand your concerns when you receive or read conflicting information. I suspect those more qualified than me will offer to help you navigate your waters called "recovery."

Hope the words help..........ICE, Elevation, Rest - REPEAT - and meds, of course......and that little red box hidden with the dust bunnies under the bed called Patience. Best wishes to you...... ~ Pat


Sorry, Minstrel - it appears that I was typing while you were typing/sending. Congratulations on your progress. Welcome to the ODIC (overdid it club) and the Energy Drain club. - be well, ~ Pat

 

[KarriB]

I found it helped to build my walking slowly, beginning with just 15 minutes of intentional walking 4-5 days a week and adding 5 minutes every week. I just started this 6 months ago and can tell such a huge difference in my TKR. It used to bother me to walk or stand for any length of time and I was always looking for a seat. But now I can walk for over an hour with no problem and stand for at least 20-30 minutes. I do think walking has worked to build up those muscles in ways that PT did not and wish I had done this sooner.

 

[Minstrel]

New Question for the Forum Moderators

Will I ever have to have my new knee replaced a second time (I am 60)?

This question recently came to light when a friend who had a knee replacement two years ahead of me, mentioned that her surgeon said as much to her. I was flabbergasted! I remember hearing several years ago that having the surgery too early in life would increase the likelihood of a second operation, and it was a big reason for me to delay the procedure. The technology was improving year by year, making it less and less likely that a replaced knee would have to be replaced a second time. Is this not the case?

On another note, I returned to work in September - walking approximately 26 hours over 9 days (ranging from 3 to 4 hours most days with extra long mid-day breaks). I found that once I was walking, it felt fine to continue doing so. After my break, I never walked for as long in the same day. And in the evenings, I was sore. It was reminiscent of what I used to feel like pre-surgery. Nonetheless, I completed my job requirements for the month with a day in hand and, according to records kept, my completion rates were very comparable to what I used to need to do the same amount of work.

Have noticed a lack of patients on this forum who are 5-6 months post-op and beyond. Any clues as to how I can readily find them?

 

[Jockette]

I am 6 months post op. My recovery is way slower than yours. You are able to walk way longer than I can. I think I'm going to do what Karri said about that.

But, I am retired, so never needed to push myself to do things.

I don't have pain that makes me say "ouch!!" but I do have a fair amount of tightness that is uncomfortable and annoying and makes me think, when will this end!

I live in a 55+ community and there have been many tkr's before me, and 2 after me. The 2 after me are "running circles" around me and to be honest, I feel embarrassed that I can't do the things they can. I have to keep being reminded that each knee has its own recovery timetable but it's hard to accept it.

Yesterday I posted a list of accomplishment goals on my thread if you'd like more detail.

 

[Jockette]

P.S. My replacement is "only" a partial, so yes, I worry about doing this again in the future. I sure don't want to!

My thread title is Patellofemoral March 13, 2017.

 

[KarriB]

Every knee is different, so no one can say if you'll have to have a revision. I can tell you my dad had a TKR at the age of 69. He's now 86 and husband first TKR is still fine. As the technology improves I believe implants are lasting longer.

 

[kmak81230]

I will be 20 weeks post op on Tuesday. I still get swollen and sore after days of long walking.

 

[Minstrel]

KarriB - What exactly is a revision (unfamiliar with the term)?

 

[KarriB]

A revision is when a first TKR needs to be replaced with a second TKR. There are revision specialists here in the US. I'm sure Josephine or Celle could give you more info, but that's the jist of it.

 

[Minstrel]

So having to have a knee that has been replaced, replaced a second time is a possibility?

Under what circumstances would this occur?

 

[KarriB]

Here's a link to information from Josephine.

https://bonesmart.org/forum/threads/revisions-what-makes-them-necessary.15005/

 

[Minstrel]

Now 9 months post-op and wondering about sensation in my knee, walking normally, and returning to more vigorous activity

Have been back at my job where I walk 3+ hours at a time for 4 months now and I have also started skating on indoor ice. It has been since August that I was officially measured - I can now completely straighten my leg, but flexion is stuck - last measurement was 104 degrees and it does not feel any more 'flexible'. I have lowered the seat on the upright bike at the gym 3 or 4 notches, so I know that I'm better able to rotate the pedals, however, I still have trouble going downstairs, especially when there is no handrail on my right side.

Thing is, I can feel 'something' (the new joint mechanism?) in my knee every time after physical activity. Based on my knowledge of knee anatomy, I would describe it as the plateau where the end of the 'femur' sits in the joint.

Because I make a point of doing something active every day - most often walking - this sensation rarely goes away. I would not describe the sensation so much as pain as a feeling that there is something in my knee (which there is!).

Especially after activity am I slow to move upon getting up from sitting. I actually stand for a good 20 seconds before taking the first step and then I waddle for several steps - I feel like I need to 'get my footing' before walking semi-normally. This really concerns me; three hours of walking is a far cry from the amount of time I was able to move even in the months leading up to surgery.

The skating has been beneficial for me for more than the physical activity - getting back to any sport is helping my frame of mind. I have been trying to go to the arena twice a week and skate for about 45 minutes at a time. This morning I even picked up a hockey stick and engaged a 4 year old by passing the puck back and forth.

The real 'litmus test' for me will be a return to downhill skiing. To that end, I am anxious for a big dump of snow so I can strap on my skis at a local hill. My plan is to start on the 'bunny slopes', however, I am concerned about the sideways motion that good ski technique requires while doing "S turns". Am I now at a point where I can go ahead and parallel ski without risking damage to my new knee? Skigirl?

Months ago I ceased to get too upset about my lack of flexion. I have gained more than 30 degrees in my total ROM, so as my surgeon has asked, "Should there be anything you can not do now that you have improved your range to the degree that you have?" For me, function is so much more important than a 120 degree bend - I haven't been able to bend my knee like that since I was a teenager. I am, however, very, very keen to get back to the activities and the lifestyle that I love, but not at the risk of damaging my new joint - I'm sure not prepared to go through any more surgeries on my left knee.

Any answers to my queries, or experience to share about the feeling in my knee, my inability to walk properly upon standing, and the return to more vigorous activity like downhill skiing?

 

[funkymuse]

Just now reading your thread @Minstrel and so happy to have found it. I continue to stumble upon and find threads of slow and steady recoveries that give me hope and continue to instruct me that the Bone Smart way is the way to go. I love your journey and how you surrendered into taking care of your knee without pushing into pain. I look forward to reading the entire thread today. Many of the members here have continued to gain ROM well over a year so it seems there is hope for improvement well beyond your 9 months!

 

[KarriB]

It was a year before I was able to get up and get moving normally after sitting for a while. It will come. There was no way I could walk 3 hours a day before my TKR surgery, my limit was a half hour or less, so a few hours a day now are wonderful. Let’s tag @skigirl to see what she says about the skiing.

 

[skigirl]

It seems that you have a good degree of fitness---and I assume that your doc thinks everything is okay with the knee. I skied at 5 months, I was very fit at that time after taking a pre ski conditioning class!! I do not notice a sideways motion in skiing---- My knees move side to side, but the ski is always connected and moving downhill. I have to say that after a day of heavy skiing, I do notice some swelling in my knee, so I think that you should try half a day at first. If that is okay, then try the whole day of skiing.

I have also moved to shorter skis and I can tell the difference when I put longer skis on my feet. I have been the elan rep for year and when the rep comes with next year's skis, I ski lots of sizes from 160 to 180. I am 5'3" and normally ski a 150 ski. After a day of skiing longer skis, I definitely feel stiff. Getting a shorter ski is an easy way to adapt to your new knee and lots of fun too!!! If you have more questions, just tag me and I will answer them.

by the way, skating is a great pre ski exercise. I skate two or three time a week myself.