TKR Patella Tendonitis after TKR - Have you had this?

[jenkneefur]

Thank you for the kind words, ladies! I do have a growing list of questions and concerns for the surgeon. Well, assuming that I actually get to see the surgeon. I've only met him once. Every other visit has been with one of his "fellows".

Thankfully, my boyfriend, who is my primary caregiver, will be with me at the appointment. He's been quite frustrated at the lack of attention to and coordination of my after-care. He is my rock, we're madly in love (lucky me!), and I couldn't imagine going through this without him.

Today was another frustrating day of PT. Still cannot bend beyond 75 degrees. I've been stuck at that number for a week. So stiff.

Luckily, today the nerve pain seems to be reducing some. I have been scouring the internet to find out what the treatments and outcomes are for people who developed post-op TKR nerve pain. The info is all over the place, as is most medical related stuff on the internet. If my surgeon brushes off the nerve pain or doesn't make an effort to address it, then I will have to look for a pain doc who will.

One silver lining in all of this... I've dropped a few pounds. Nausea isn't the most sensible diet plan, but I'm not complaining about this extra perk. ;o)

Hope everyone is having a pain-free/reduced day! :o)

 

[sunflower]

Jenkneefur, does the ice pack seem to help the pain? You've been so uncomfortable and it's no wonder you're making little progress in PT. Your boyfriend sounds like he will be an excellent advocate for your medical care and perhaps he will encourage the OS to be more proactive about your care and (insufficient) pain management. You have a cheery attitude despite your hardship.

 

[Josephine]

Jennifer, I've just realised I have no idea when you had your surgery. But assuming it's only a couple of weeks out, you should not worry about having lost two weeks of 'critical' recovery time because there is no such thing. You don't need a CPM. They are more of a placebo than a help. What you do need is to attend to the four musts of recovery - rest, elevate, ice and take your pain meds by the clock. Are you doing these things? Really and truly?

Here are some articles you need to read
The importance of managing pain after a TKR and the pain chart
How Long Does Healing Take ......
Chart representation of TKR recovery
Energy drain for TKRs
Elevating your leg to control swelling and pain
Using ice

Knee Replacement - Where Am I in Recovery?
So What Is It Going to Take? The Five “P’s” of Knee Recovery
Work “Smarter” and not “Harder”
About recovering a knee - from one who knows!
Some suggestions for home physio (PT) and activity progress
Myth busting: The "window of opportunity"

Also, if you could be a dear, would you put your surgery date in your signature like the rest of us do? Thank you so much
You can find the instructions here How to create a signature.

 

[Roy Gardiner]

Still cannot bend beyond 75 degrees. I've been stuck at that number for a week. So stiff.

Please don't worry about it, a week is no time. Your knee has been severely assaulted, it will get better. Just gentle stretches only needed to help.

 

[jenkneefur]

Thank you, Josephine for all of those helpful links! Especially the one about busting the myth of the window of opportunity.

To answer your question, hopefully I've been doing my best with rest, elevation and ice. I've done all my PT work and religiously ice and elevate with the help of my loving boyfriend who stays on top of all of it, including my meds (for those times when my head is too fuzzy to remember). He even made up a spreadsheet with all my meds and instructions. He's my hero.

I'm not sure why my signature info was unchecked when I posted, but I edited the post so it should show now.

Well, wish me luck, break a leg, or knee, or some such thing...I'm off in a few minutes to get my staples out. Woohoo! :biggrin:

 

[Josephine]

 

[jenkneefur]

Hey all! I'm just curious to know what your goals are for range of motion and flex, and what your docs and PTs say is reasonable to expect. I had TKRs at the end of February and May and still go to PT three times per week. Both are at 125 without assist. But I'd really like to be at 135-140. Just wondering if others got that far. Thanks!

 

[Janet2012]

Some people are there or beyond. My goal is to get to where my knee will go, and I have no idea what number that would end up being. It's not really like making a choice off a menu, it just ends up there. Good luck and hope you get there!

 

[1ELISEA]

Doesn't some of the amount of flexion depend upon the type of implant?
Or is that all marketing hype and they can all mechanically obtain 140 degrees? Josephine;
Before I give out misinformation, let me ask Josephine.

 

[Elsie Yan]

Sounds to me that you are doing quite well already, Jen. My OS said that if I don't achieve max ROM within 6 months after surgery, it would be very difficult to increase any further. So I tried very hard but it didn't improve very much within the 6 months. I have never really measured my ROM but I think it was about 120 at 6 months. Well, I have stopped trying to chase any magic number, Ever since I joined this forum, I found that others in advanced recovery have said that they continue to see improvements in ROM. And its absolutely true. I have seen improvements in my ROM without really noticing it until I experienced something that made me realize that hey! I could bend like that already. So its a pleasant surprise and I am at peace with my ROM now, whatever that number is.

 

[jenkneefur]

I can see where different implants could achieve different ranges of flex. I have Zimmer gender specific knees, but I have no idea what the range is for them. My doc (pompous jerk but great surgeon) doesn't think it's important info for me to have -- dodges question.

 

[Campervan]

I have a Zimmer knee, don't think its gender specific and its definitely not high flex because he told me he won't fit those because the New Zealand National Registry is indicating they're showing early signs of wear at the back. I was told to expect around 130. Up to six months I had around 105-107 and then jumped at 7 months to 117, but drifted back to 111 at 7.5 months. I just want enough for daily living within stress and to be able to walk distances up and down hills.

 

[Celle]

I have no idea what my ROM is, but I "guesstimate" it to be about 120. It's enough for me to be able to do everything associated with my day-to-day living. I know my TKR leg doesn't bend quite as far as my un-operated leg, but I'm sure it will, in time. I still do ROM exercises - when I remember!

 

[Josephine]

There are optimum degrees of flexion for certain activities but I can't seem to find the article. I remember it said that 90* is minimum for climbing stairs. But in truth, there is no particular limit according to prosthesis. Most of the limits are imposed by anatomical things such as obesity or tight ligaments. But the maximum range for a small knee could be as high as 140* but I've never heard of anyone getting to 145* yet. I would say that a ROM of 125-130* is excellent for the average person. I found these comments from synopses of medical articles (couldn't get into the main article - costs too much!).

broken link removed: https://www.springerlink.com/content/27k641812n3t5236/
Although high-flexion TKA designs aim to safely accommodate deep flexion, it is unknown how often patients use deep flexion outside the laboratory. We used a validated smart-activity monitor to document the prevalence of knee flexion greater than 90° in 20 consecutive patients (21 knees) who had high-flexion TKAs, at a minimum of 2 years’ follow-up. Patients wore the device continuously for a mean of 35.7 ± 0.5 hours. The 21 knees flexed more than 90° for an average of 10 ± 3.8 minutes (0.5%). Activities performed with flexion greater than 90° were, on average, 70% in single-limb stance, 12% moving from sitting to standing, 8% walking, 7% moving from standing to reclining, 2% stepping, 0.9% moving from lying to standing, and 0.1% running. Eight knees flexed greater than 120° for an average of 2.2 minutes (range, 0.2–15 minutes), or 0.1% of the testing time. Activities performed with flexion greater than 120° were, on average, 90% in single-limb stance, 6% moving from sitting to standing, 3% walking, 0.6% moving from standing to reclining, 0.3% stepping, and 0.1% moving from lying to standing. Peak flexion used at any time during testing was, on average, 84% ± 11% of maximum postoperative flexion (125° ± 12°). These patients rarely used deep flexion.

LINK
High-flexion total knee arthroplasty is considered flexion beyond 125°. Certain activities and a number of workplace demands benefit from this greater range of motion. Some cultures and religions place more emphasis on deep knee flexion. Important patient factors include preoperative motion, body mass index, and previous knee surgery
The range of motion after a total knee arthroplasty may be the result of design, preoperative range of motion, culture, and psychological concerns.

LINK
For example, authors report that to squat one requires 130°-full hip flexion and 111°-165° (or full) knee flexion. To sit cross-legged one requires 90°-100° hip flexion and 111°-165° (or full) knee flexion.

 

[Roy Gardiner]

I'm at about 130-135, although I don't measure it. I keep stretching, it keeps improving. Unless I forget to stretch, then it doesn't . AFAIK the actual joint doesn't limit you, it's the surrounding tissue which does.

 

[speccybecky]

Before op surgeon said 130 was what he aimed for but that not everyone got there

 

[Jebsw]

I'm five and a half months out. My flexion is 133. Surgeon feels that is fantastic, even seems a bit surprised at how good it is. I have a LOT of what they gently call soft tissue (I.e. fat legs) so this is really good. I found playing around in the pool helped - the buoyancy helped me do squats and I could actually feel the ROM improve as I did this a few times. Extension is 0. Stryker implants. Happy patient.

 

[ChrisO]

Jen,

I guess the question you need to ask your OS is not what your max flexing is but can you do whatever activity you think requires a flex of 140 degrees.

In my pre arthritis life I liked to do home projects, I wonder if I'll ever be able to lay a house full of ceramic tile like I did 10 years ago, I don't think I'd take on that big a job ever again but I have some ideas for my kitchen.... I can't sit on my legs and heals just yet but I can tolerat being on my hands and knees for short periods of time. I still can't get up off the floor but I'm working on it.

ChrisO

 

[Josephine]

Actually, there was one point I missed out. If the knee is hyper-flexed too much too often, it can risk damaging the back edge of the plastic insert. I don't know if it's specific to some makes or general.

Perhaps Orthodoc can add something to this.

 

[Jebsw]

My doctor warned me about that, said "not to get all stupid about it" and try to go for even 150, saying too much more was not necessarily a good thing. ( I love my dr., and he was just kidding about the 'stupid' comment.)