TKR Poly Exchange at 10 months post TKR

[Elyse]

Have good flexion but not extension. Orthopedist recommending poly exchange in October 2023. (TKR January 2023). Skeptical about whether this will work or just make my knee too loose. Anyone had experience with poly exchange for this within a year of TKR?

 

[sistersinhim]

@Elyse, hello there and welcome to Bonesmart. When exactly was your tkr and which knee was it? I will add this information to your signature for you. This helps us all to know about your surgery.

You are early in your recovery which normally takes at least a year to heal. Receiving a flat knee, (extension), is usually to last to achieve. It's a common complaint and I'd give your knee at least a year to reach that goal. Mine also lagged behind and I was able to help it along by walking with a longer than normal stride, with a heel-to-toe gait. This helps to stretch out those large tendons and muscles in the back of the knee. It didn't happen overnight, but it did work for me.

Even though you had your surgery 5 months ago, I'll leave you your very own recovery articles in the next post. Many find these very helpful in their recoveries.

 

[sistersinhim]

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

KNEE RECOVERY GUIDELINES

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.

4. PT or exercise can be useful BUT take note of these
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy

5. At week 4 and after you should follow this
Activity progression for TKRs

6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here

Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

Try out our great new opportunity to improve your gait. It's OneStep. It's free and you will find it to be a huge help to you. Click here: OneStep

 

[Elyse]

Thanks for the info. TKR 1/26/2023 on right knee. I am aware of time it takes for recovery, but the orthopedist is concerned about the lack of full extension which makes it painful to walk. I still have significant pain at night.
Just prior to surgery I was very fit, able to walk 15-20 miles a week, play pickleball and did competitive indoor rowing, although knee MRI showed extreme damage. I have done multiple exercises, had PT and used JAS brace for past 5 weeks. No change in extension whether I do these things or do nothing.
The information I am hoping to get from this group is whether anyone else has had a poly exchange to improve extension (within about a year post surgery). Also wondering what tests might aid in my decision making. Had lots of x-rays but no MRI post surgery. Maybe not useful? I do not intend to rush into more surgery and likely will delay scheduled October surgery, but it is concerning to me and surgeon that my extension has not improved even one degree in the past 3 months.

 

[EalingGran]

Have you tried lying on your bed on your tummy with your legs hanging off the bed as a way to improve extension? I can't remember who suggested it here on BoneSmart but it definitely helps.

 

[Elyse]

Yes, that has been one of my exercises. I don't believe there is an exercise I have not done! Did PT 3 times a week until recently stopped since not working.
Thank you for responding.

 

[Jaycey]

@Elyse Why is your surgeon so anxious about doing more surgery so early? As sisters said above, recovery from TKR can take one year or more. Many of our members achieved increases in their ROM at or later than one year out.

 

[Elyse]

My flexion is fine and has been since 4 weeks post surgery, but extension seems intractable. No improvement whatsoever, not even gradual improvement. Also have moderately severe medial pain. 10 months vs 12 months doesn't seem like a huge difference to me, but likely I will wait at least 12 months or longer if it ever begins to improve.

 

[Elyse]

At 5 months post TKR I am suddenly having a significant increase in pain and swelling. Knee very hot, but not red. Lost flexion and extension. No increase inactivity. Ice and rest (orthopedist recommendation) does not help. I am scheduled for a poly exchange in October for lack of extension, but not flexion. Now both are a problem and much worse. I will get back to orthopedist a second time, but meanwhile trying to understand what happened. Only change is in medications I am taking for lung infection, but infectious disease doc doesn't think it is that. Anyone else experience such a sudden increase in pain at 5 months? Was walking 3-4 miles and now just limp around the house.

 

[Layla]

Hello Elyse,
I am sorry you're suffering with a significant increase in pain and swelling. Consider contacting your surgeon for advice rather than struggle until October especially since you're unable to attribute the changes to anything specific. Once you have a date for the procedure to take place in October, please share and we will edit your signature accordingly.

We have merged your newest thread with your original recovery thread. Having your recovery information contained in one place will make it easier for you to reflect back on. It is also helpful for those stopping by to be able to review your history before advising or commenting.
Please post any updates, questions or concerns about your recovery here. Let us know if you'd like your thread title changed to reflect your current issue and we'll gladly change it for you.
Best Wishes for your comfort!
@Elyse

 

[IndigoKnee]

Hello Elyse,
Have you any further news on this? I am especially interested as I seem to be in the same boat. I had my TKR a week before you and I was starting to do well and enjoying walking again but the knee gave way a couple of weeks ago and is now stiff and painful so I am also reduced to hobbling round the house. I'm feeling very down and upset. I had only increased my walking very gradually and was managing 2-3 miles a day and I am at a loss to figure out what is going on. I've arranged to see my surgeon at the end of July, which was the first available appointment.

 

[Elyse]

Thanks for your response. Sorry you are having the same problem. No news yet. My knee continues to be more stiff and painful and I'm still limping around. I saw the surgeon again, but he has no idea why, just suggests poly exchange. I am nervous about more surgery when he doesn't really know why it is problematic. He is a well known surgeon at University of California Davis Medical Center in Sacramento. Was told by nurses and other docs he is the one they go to. Also did a friend’s TKR the month before mine. She is older and much less fit but has no problems.
I am scheduled for a second opinion with a doc at UC San Francisco Medical Center July 25th and am trying to schedule a third opinion as well with a doc at Sutter Med Center.
Considering delaying the surgery to see what happens, but it definitely is not improving at this point. My problem has always been extension (straightening), not flexion but with the swelling and stiffness flexion is less. Still mostly poor extension. Is your problem extension, flexion or both?

 

[IndigoKnee]

I am also very nervous of the prospect of more surgery as the first time was so much worse than I had imagined. My extension has been ok since fairly early on but the flexion is still only about 95/100 (I am not able to measure it) When I saw my surgeon at the 3 month mark he wasn’t concerned by that and said it would gradually improve - which is what other people on this site had said. It is very frustrating as I had got to the stage 5 weeks ago of finally being pleased that I had the operation, enjoying good walks, and now I can barely walk round the house without pain and I don’t know why.