TKR Post op ROM

[Jockette]

Do you think your knee is still upset from using the tractor last week? As sistersinhim said, if you have more swelling, that will reduce your ROM. Sometimes it can take a long time to recover a set back.


I had a really bad set back at 4 months, due to a weekend away visiting friends. My ROM was pitiful by the time I got home. It took a month to even begin to recover.

At that point, at 5 months, my son got married. The wedding was 90 minutes from where I live and involved activities for 3 days in which I had limited opportunity to ice and elevate, and too much standing. I was back to square one again.

My ROM was poor the rest of that first year with a really tight leg. But, after the one year mark it improved, and continued to improve even after the second year mark. And now at the 3 year mark it’s even better.

 

[Jamie]

Not overdoing things with your knee is important, but it doesn't mean you should "rest" to the point of doing nothing and then try to be somewhat normal again. It sounds as though that may be what you've been doing. You have to find a comfortable starting point, do some movements or exercise every day and then gradually increase it over time.

Take a step back and allow yourself to spend a good bit of time icing and elevating your knee each day. But....intersperse that with a ten-minute walk every couple of hours or 5-10 slow minutes on your bicycle with no resistance. Maintain this schedule 1 week. If you experience any pain or swelling during this level of activity, slow it down even further until you can do the walking, some gentle bends and stretches or some turns on the bike with little impact the next day.

If you can go 1 week with only minimal pain or swelling, up the activity slowly - like 5 more minutes on the bike or 5 minutes longer to walk each time. Try that for another week to see if you still have minimal pain and swelling.

Then add a new activity or two each week - slowly so you can see if there is any negative impact. Just keep building on this concept and realize that recovery can easily take 6 months before you feel somewhat normal. For some people this may be a year. This is tough surgery and recovery really can take a long time for some people.

If you can hire your outdoor chores done for a while, do that. Trying to work on a tractor is one of the most difficult things you could attempt. It may seem like you're just sitting and maybe trying to work the pedals now and then. But in reality your knee is enduring constant vibration from the machine and bumps as you move along the ground. This is torture for a new knee and I'm not surprised you're feeling the impact of it.

If you choose to adopt the program I've laid out for you, please feel free to come here and talk about how it's working (or not working). Let us know what increases you want to make and we can help you decide what might be a little risky for you at this point. I know you are impatient to be back to normal, but you need to do whatever it takes to fight that and to fight the feelings that you're not progressing "well enough." You're going at your speed. That is the RIGHT speed for you. You cannot compare your recovery to anyone else. You must listen to your body when it tells you that you're doing something that's pushing yourself too far for that stage of recovery. Your body will tell you when you can begin to challenge yourself a little or when you should scale back.

 

[markbet]

No, my ROM regressed prior to using my tractor. I read on here that doing everyday normal activity around the house is enough exercise to work my knee, is this not true? I don’t do stretches or the exercise bike any longer. I do admit that I don’t elevate or ice hardly at all, but when I do, it doesn’t seem to make a lot of difference. I was holding on to the theory time would naturally loosen my knee. I just hope I haven’t done irreversible damage by quitting my in home exercise.

 

[markbet]

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will gradually increase.

This is what I have been following for my recovery. And it seems my swelling is down along with pain.

 

[Jockette]

I didn’t have an exercise bike, so that was not part of my activities. I only used it maybe 3 times in the early days at PT, with very painful results.

Once I stopped PT I didn’t do any specific stretches or exercises, either. My particular little partial that was supposed to be a quick recovery took well into my second and third year to really heal and relax.

I do still have other issues, but my ROM is not one of them.

If doing your in home exercise was maintaining your swelling, how does that help you? ROM does not improve much if there is a lot of swelling.

There are many opinions on this recovery that contradict each other. We have to figure out what works for each of us, and we figure that out by trying different things.

Because I was expecting a 2-3 month recovery from my partial, and of course that didn’t happen, I worried my whole first year. My knee was not in great shape at 4 months. But over time it improved a lot.

I do still have issues. My bendable ROM is fine, but I can’t put any weight into the knee when it’s bent. Going downstairs foot over foot can only happen if it’s a shallow step, and I dearly need the handrail. Going up steps is better, but not great. My knee often feels like they took my leg apart and then just stuck it back together again, without lining it up right. I have some very uncomfortable nerve damage on the lower lateral side.

I firmly believe that all the exercises and stretches and bikes in the world would not have given me a better outcome. Either something didn’t go right in my surgery, or my body just doesn’t like the implant (my first second opinion surgeon told me that,) Or I’m in that small percentage that “just didn’t get a good outcome.”

I started out with “all the PT” that just made everything worse. Even before I found Bonesmart I figured out for myself that doing all the painful PT I was doing, was counterproductive. By stopping those things, I don’t feel I did irreversible damage to my knee, I feel I stopped a bad situation from making things worse. Bonesmart has too many members who had great outcomes who didn’t do a lot of formal exercises and just got on with their lives and activities as they were able, for me to feel it’s a bad thing to do.

I fear I have a revision in my future. And I literally do fear that. There is no way I want to go through this recovery again. But if and when I do, there will be no formal PT and I will treat my knee gently and give it all the time it needs to recover. I will have much better expectations next time. Time is what got my present knee to be as good as it is, in spite of it’s issues. It wasn’t good at all the whole first year, but even with my issues, it is so much better now than it was that first year, which is why I’m no longer seeking second opinions (I’ve had 2) and I’m just managing, though I will never call this partial a success.

Don’t give up on your knee. It is still early in recovery and you have lots of time to improve. And if things don’t improve over time, then maybe something else is going on that will have to be addressed, but right now it’s way too early to know that.

I really do understand your frustrations, I had them, too. I often questioned if I was doing too little to help my knee. But every time I tried to do more in the way of “exercise” my knee felt worse. I tried to make my knee go up and down steps and I ended up hurting my arm because I was holding my cane so tight because it hurt my knee to force it to do steps. And this was at one year post op!

Time is what made my knee better. And it was a lot more time than I would have liked.

 

[markbet]

I just did a light bike ride, only five minutes. Raised the seat up to the level it was in the beginning. I had some pain, the knee was tight, but tolerable. After the ride, I did a few easy stretches. End result, my knee seems looser!! It is somewhat swollen on the inside, but still feels looser. So, instead of a rigorous workout, I’m going for easy does it. Basically starting over but not going crazy this time.

 

[Jockette]

That’s great!

I didn’t mean to imply that I never stretched my knee. I did, but gently. Until recently I belonged to a bowling league. I started back bowling at 12 weeks, carefully. It took a month before I was back to 3 games at a time. Because at that time I couldn’t bend well, I had to change my approach to the throw line.

Anyway, the seats there swing in and out, I used that as one of the ways I’d stretch my knee. As I swung in, it would make my knee bend more. I’d just do a few at a time.

There are lots of ways to give your knee a stretch in the course of your activities.

 

[markbet]

Bowling at 12 weeks, that is actually pretty impressive! I try the simple stretches. Maybe while watching tv, I will wrap my left leg over my right and draw it in some to get it to bend.

 

[Jockette]

Well, I was throwing the ball at 12 weeks. My husband had to help me put my bowling shoes on and tie them for me for weeks. My balance was still off, so I couldn’t handle my rolling tote until I was about 6 months. I only bowled one game the first day back with a whopping score of 70. Thanks to pure luck I did have one strike! After that first day, I started doing 2 of the 3 games for the next month, bowling games 1 and 3 and resting during the middle game. It’s really not as impressive as it sounds.

Which is why we really have to be careful when we hear so and so was doing ____ at such and such a week post op. We picture that person doing that activity at a normal, fully healed level, which is most likely not true and we don’t have those details.

@Celle has a great illustration about her friend, Will. It’s an eye opener!

 

[Jamie]

I just hope I haven’t done irreversible damage by quitting my in home exercise.

Please don't worry about this being the case. You are fine. I like your idea of making a new start and I'm glad to hear you're incorporating a stationary bike into your program. It's one of the best activities for your knee as long as you take it slow and increase times gradually. No resistance at all as you're working on mobility and not strength.

It's true that you can recover with just activities of daily living. However, most people do better with some challenge of gentle bends and stretches daily. It sounds like you are on the right track now. If you have stairs, you can put your operated leg up on the bottom step and gently lean into a bend. Once you get to the point where it's tight and just barely uncomfortable, hold that for a count of 5. Do that 10 times twice a day in addition to the bike.

 

[markbet]

@Jamie Yes! I am in total agreement. I started riding for five minutes, today I increased my time to ten minutes, and light stretches. I know this isn’t going to make any sense, but my knee is a little tight, and yet it seems looser!

 

[Jamie]

What you're feeling makes perfect sense. The "tightness" is a normal feeling after surgery that comes from swelling when you move or exercise and can last a while. You want to minimize this. But the "looseness" is just that. Your gentle motion is keeping the knee more mobile and lubricated. This is what you want.

But.....increasing from 5 to 10 minutes when you're just starting on the bike isn't taking it gradually. It's okay to stay at 10 minutes as long as you don't have more than just mild tightness afterwards. Don't increase it any more for at least a week. You need to stay at these levels for at least a week to really be progressing gradually. Go faster and you'll have swelling.

Patience! It's the most difficult part of recovery.

 

[markbet]

Is it pretty normal to have swelling of the foot of the leg that received the TKR?

 

[Jockette]

At this stage, yes. My leg still swelled at that point.

 

[sistersinhim]

Yes, I had swelling for quite a while. Even both of my feet peeled. Crazy looking!

 

[markbet]

What is also odd, lately I’ve been having cramps in the bottom of this same foot. Cramps in the bottom of my foot? This is new and has never happened before.

 

[sistersinhim]

You are probably walking differently now than what you were before your tkr. Try to concentrate on walking with a heel to toe gait. You also might need some new shoes since your old ones will have a wear pattern already. Your new shoes will allow your knee and foot created a new wear pattern in new soles.