TKR Post op ROM

[mog]

Hello world thank you all so far for some really useful advice. I had TKR on right leg 28 Nov. 2019 and saw my surgeon yesterday who (briefly) saw me asked me to bend- 80 deg. only to be INCORRECTLY told you are not doing the exercises!! I have been doing the pathetic A4 sheet i was given at discharge and extra from PT to which he said they are no good for YOU(i had a failed ACL replacement 20+ years ago and have been wearing a brace for around 6 years so i could continue working so have little to no muscle strength). He also commented that i left with straight leg raise AND 90 deg. bend- i had to strongly disagree with this as i was dischrged no staright leg lift and 45 deg bend. He has given me 2 weeks to get to 95 deg or i face MUA. Please believe me i am trying but so painfull and even with ankle weights/ forcing it will not go and just swells making walking(which i could do) difficult AGAIN. Has anybody got any advice/ ideas how to get the ROM i need quick as i really don't want MUA and longer off work.
Thank you.

 

[Jockette]

Hi, mog, and Welcome to Bonesmart!

I’m so sorry that you have a surgeon who believes a certain ROM number must happen by a certain date. Some of us take longer to achieve certain numbers, and that’s ok. The real truth is, ROM can continue to improve well after the whole first year, and even longer than that. My ROM continued to improve even after 2 years!

You really should stop trying to force your knee to bend, because, as you found, it only upsets your knee further, causing more swelling and pain. It is swelling that is preventing your bend. Also, weights are bad for a new knee, putting too much stress on it, so stop using that, too.

Contrary to popular opinion, we get far better results when we treat our knee gently so it can heal from this major surgical assault. Any exercises we do that cause pain are counterproductive.

So, take a deep breath and take a break from those exercises so your knee can settle down. Rest as much as you can, ice and elevate your leg as much as you can. Just walking around doing the normal things you do in the course of your day will be plenty of exercise for you right now.

Also, the final decision about an MUA is actually yours. Your surgeon can recommend it, but you don’t have to consent to it, and he can’t do it without your consent.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Knee Recovery: The 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 to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Jaycey]

@mog Jockette has given you some very good advice. But I'll add a bit of input as well. Your case is not "by the book" by any means.

i had a failed ACL replacement 20+ years ago and have been wearing a brace for around 6 years so i could continue working so have little to no muscle strength

If you have been using a brace for 6 years this knee is not going to just bounce back. It took time to get into the pre-op state. It will take time to regain ROM.

Please do not be bullied into MUA. Still very early days for you. Ice, elevate and get control of the swelling that is limiting your ROM. Then start very gentle bends. All you knee needs is time.

 

[mog]

Thanks for reply Jockette. I know what you are saying is right it is just so hard my Wife has been amazing but our daughter is also unwell and off school(weeks and weeks) and the company i work for has been taken over and already layed off people around the country so i just need to get fit ASAP but as safely. I have learnt after previos ops. rushing back to work only makes things worse. Would MUA actually speed up process??

 

[mog]

Thank you Jaycey as i have just posted MUA will it speed up process??

 

[Jaycey]

Would MUA actually speed up process??

Most likely not! It will basically put you back to square one in this recovery. Initially you may have increased ROM. But you will also have all the swelling from that knee being forced during the procedure. And my guess your surgeon will want you to have aggressive PT post MUA. It's all a recipe for more pain and frustration.

Your surgeon sounds like someone who believes there is a "window of opportunity" for ROM. That's simply not true. Some patients take weeks to gain ROM. Others take months or even years. Read this article from the list Jockette posted Myth busting: the "window of opportunity" in TKR.

 

[Helizabug]

I’m in a similar situation, @mog, though my work situation is easier.

I’ve got until Jan. 31 to decide whether to reject or accept the MUA procedure because I doubt I will hit the marks my doctor has set.

I’m working harder at improvement than I was, but still not pushing to that edgy pain that brings tears to my eyes. If the work creates more damage, I ease up. I think I know the difference between ‘pushing’ and ‘rending,’ and that feels like a good approach. I learned this from BoneSmart.

Of course, if you follow the BoneSmart approach, it would suggest that an MUA is the epitome of ‘rending.’ So, it’s a hard choice.The research shows, if I understand correctly, that in the long run, you won’t be any better off with an MUA, but in the short run, it can feel successful in a high percent of people.

There are people on BoneSmart who tell their MUA stories. You can find them by the MUA tag. When you find one, look at the date of the MUA in their signature, then hunt down the posts around that date to see what it was like for them, in the short run.

 

[loneshark64]

Hey Mog. Sorry you are going through so much stress. This is just two cents and I don’t know what country you are in. I have significant experience with company acquisitions, many years. These days more than ever there are layoffs after acquisitions especially where private equity is involved. But in the US they generally are quite careful not to lay off people who are out on medical because it is a protected class and they often get sued. They may come to people with a buyout offer but my 2 cents, not knowing your situation at all, is to put that fear aside and get your body right.

 

[LD of Michigan]

Yep. My doctor is a grand surgeon and also believes in the 'window'. I agree most knees get more ROM over time, especially flexion IMO. Don't be hard on yourself re. the rushed expectations.

Your surgeon sounds like someone who believes there is a "window of opportunity" for ROM.

 

[mog]

thank you all for the support. Loneshark64 i am un uk, i think we have the same 'protected' status here but it doesn't stop the brain overthinking stuff when you are stuck trying to juggle all the different views of rest or WORK HARDER(from surgeon- don't worry i calmly let him know how wrong he was).
I have been fortunate to speak to a family friend that used to be PT and has had enough of our stretched NHS and not having enough time to properly get to know the patient and they recommended some great exercises and brain re-training and to try a forum(best one so far)

 

[loneshark64]

Yes U.K. you have that in your advantage. I also overthink my own stuff, lying here, so I get it.

P.S. I have decided to give up my Royal status. So no HRH for me anymore. The cat still expects royal treatment however.

 

[mog]

good to see you have kept your funny bone intact .Wishing you a speedy full recovery.

 

[Celle]

@mog - I agree with the advice you've been given. There is no window of opportunity, and your knee will need special consideration, and gentle treatment, because of the weakness it had before surgery. While it could take longer to achieve ROM, it should get there in the end, as long as you don't allow aggressive PT to cause it more trauma.

Whatever your surgeon recommends, remember that it's your knee and you are the only one with the right to say what happens to it. Your surgeon can recommend, but you have the right to choose whether or not to follow his recommendations. He cannot do anything without your permission.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

Here are a couple of examples from people whose ROM was slow to develop, but who got there in the end:

This is from 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
128 – 6 years "

And this is from bertschb:
I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.

 

[sistersinhim]

Would MUA actually speed up process??

Let me show you the stitches you have inside your knee. An MUA will pull on those stitches and maybe even pull some apart. That means more swelling and pain, adding to your recovery time. The very best way to heal is to just do what you normally do during your time at home. Walk around, brush your teeth, and your hair. Make a sandwich, get a drink. Go to the bathroom. All those types of things are PT. But, they are gentle, and will cause much less inflammation to an already inflamed knee.
https://bonesmart.org/forum/threads/closing-surgical-wounds-how-is-it-done.4286/#post-90691

 

[sistersinhim]

I was blessed to have a surgeon that never pushed PT. He gave me a prescription for it, which I threw away and never went. When I went for my 3 return checkups, all he wanted was to see what my knee would do. Never one question about PT! Of course, he knew I was a single lady that had to take care of myself, so obviously he trusted that I would not be just laying around all the time.

After 11 knee surgeries, I know that I do not need PT, and neither does anyone else if they do their own daily activities. My knee recovers just fine all on its own with only my daily activities. I didn't have the terrible swelling or agonizing pain that so many have after taking formal PT either. I knew the Bonesmart way worked before Bonesmart was even thought of. My surgeries started in the early 80s and I never went to PT even back then. I just didn't see the need for it. Bonesmart was formed around 2004. By then I had already had 6 knee surgeries and rehabbed the Bonesmart way!

 

[mog]

thank you Celle and sistersinhim both incredibly helpful and eye opening. When you step back(no pun intended) and think about it my knee feels a lot happier and easier to walk on being gentle, i have tried being more aggressive- yanking on a scarf over my shoulder and nearly passing out with pain( i will try almost anything to avoid more surgery) and then not being able to walk properly.

 

[Tykey]

Hi Mog, I'm another Brit, now 4 1/2 months out. My very pretty NHS physio called Kiss (although saying she didn't know of Bonesmart) quoted our philosophy almost verbatim.

Ie just don't sit still, get on with life, and if it swells up, let it recover, then try again".

Everything is progressing brilliantly

Do you remember Tommy Cooper saying he went to the doctor and said "Doctor, it hurts when I do this!"
The Doctor replied "Well, don't do it then!"

 

[Roy Gardiner]

He has given me 2 weeks to get to 95 deg or i face MUA.

It's your knee, he can't force you to do anything.

Please believe me i am trying but so painfull and even with ankle weights/ forcing it will not go and just swells making walking(which i could do) difficult AGAIN

Pain in therapy is never helpful.
Imagine working through pain to recover a broken leg or a sprained muscle; you can't, and walking on a broken leg or exercising a sprained muscle are counter-productive, obviously. It's much the same with TKR, you have damage needing healing, not unfitness needing training.

All you need is to help retain mobility (not fitness or strength) until healing is complete. This is done with gentle stretching exercises, without pain.

If you have adhesions then yes you will need MUA, but you won't know this until after the swelling has gone down. Give up on pain, please!

 

[mog]

oh darn!!!!!
i have been doing my exercices seen PT (not very impressed with OS comments) and yesterday tried gently stretching on exercise bike and made a massive mess up somehow managed a complete revolution!!!! OUCH looking at left leg i am guessing around 110 deg. movement. After ice ect. seemed upset but could still walk and bend a little further. Today swollen and painful to walk on and bend- i have appt. to se OS Monday and i am not looking forward to it now. Come one you lovely people do i
A:- not say anything and go with MUA proposal or
B:- Let him (politely) know i tried and forced my knee as HE instructed only to be left swollen/in pain so no thanks i will continue with GENTLE option- longer but i am thinking better for me.
Sorry for rant/whinge but i hope you all understand.

P.S. i am going to try my osteopath Tuesday as everything else he has sorted perfectly has anybody else had osteopathy and or acupuncture?
Love and get well soon to all.

 

[Jockette]

so no thanks i will continue with GENTLE option- longer but i am thinking better for me.

You must do what you think is best for you, and you feel gentle is the way to go.

You are 2 months into a 12 month, on average, recovery.

There are so many varying opinions about this recovery which means your opinion counts, also, and it is the most important.


This is what @TortiTabby experienced. (Just so you know, ADL means Activities of Daily Living, which means just go about the normal things you do in the course of your day, and not doing a “list of exercises.”)

Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better.